Il trattamento dei traumi addominali chiusi.

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COD: 149-154 Categorie: ,

Guido Basile, Stefania Chiarenza, Pietro Di Mari, Antonino Primus, Giuseppe Boscarelli, Antonino Buffone, Ercole Cirino

Ann. Ital. Chir., 2006; 77: 149-154

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BACKGROUND: Aim of the study is to work out diagnostic and therapeutic guidelines in blunt abdominal trauma, considering
our modern diagnostic tools and actual international propensity for non-operative treatment.
METHODS: Seventy five patients observed during the last three years at Emergency Surgery Unit of “Vittorio Emanuele”
Hospital in Catania, Italy. All patient underwent, after blood tests, abdominal ultrasound and/or CT, showing one or
more abdominal lesions in 52 (69.3%) of them. Out of these 52 patients with organ injuries, 29 (55.8%) underwent
surgery, while 23 (44.2%) non-operative treatment: the most injured organs were spleen (34 cases), liver (18 cases) and
kidneys (4 cases). On the basis of haemodynamic conditions of the patients and of the results of abdominal ultrasound
and/or CT, the Authors decided between surgical or non-surgical treatment, working out in the meantime their diagnostic-
therapeutic guidelines.
In Authors’ experience, while for splenic injuries the majority of patients was operated (splenectomy), for hepatic injuries
non-operative treatment was preferred, as well as for all renal injuries.
RESULTS: Two patients (2.6%) died because of hypovolemic shock secondary to an high-grade hepatic trauma associated
with d.i.c.; both patients reported other major lesions of, respectively, chest and brain. Other 4 patients developed postoperative
complications: 1 patient a pleuritis and 3 patients a wound infection. All these patients recovered with antibiotics
and, where necessary, repeated change of medical dressing. The other 69 patients recovered completely, without
any significant complication.
CONCLUSIONS: The study of personal experience of the last three years on abdominal blunt trauma (75 patients) has
allowed the Authors to work out diagnostic-therapeutic guidelines, which are based mainly on patients’ haemodynamic
conditions and on sonographic and CT results. The applications of this protocol has allowed the Authors during last 12
months to practice more frequently the non-operative treatment, avoiding unnecessary surgical operations, sparing the
patient organic deficit and possible intra and post-operative complications.

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