Treat the Patient Not the Image: Non-operative Management of High Grade Solid Organ Injuries in Abdominal Trauma PC12-PC15
Dr. Sumesh Kaistha,
Associate Professor, Department of Gestrointestinal Surgery, Command Hospital, Bangalore-560007, Karnataka, India.
Introduction: Trauma is a modern day epidemic. Abdominal trauma is the most common cause of trauma-related death that is preventable. Non operative Management (NOM) is increasingly being done in Blunt Abdominal Trauma (BAT). However, for high grade injuries, the risk of failure of NOM has been shown to be higher.
Aim: To assess the feasibility and success rate of NOM in abdominal trauma with high grade solid organ injury.
Materials and Methods: The present study was a retrospective review of a prospectively maintained database at a Tertiary Care Centre. 17 blunt trauma abdomen cases with high grade solid organ Injuries over a period of four and a half years without peritoneal signs or persistent haemodynamic instability after initial resuscitation were included. Data was analysed using online statistical software (graphpad).
Results: Of the 17 cases with high grade injuries, two had contrast extravasation on imaging. Predominant organ involved was spleen in 11 (64.8%), liver in 10 (58.8%) and pancreas in one patient, respectively. NOM was successful in 100% of patients. Three patients had rebleeding and all were successfully managed non-operatively. There was no mortality.
Conclusion: The NOM is feasible and safe even in high grade injuries in BAT. This decision is based on a sound clinical judgment and should be attempted at centers with facilities for critical care, interventional radiology and adequate blood bank facilities. The patient condition and not the grade of injury on imaging should dictate the line of management.