The treatment of blunt abdominal trauma. Personal experience

Abstract

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.