Non-surgical follow-up success in blunt abdominal trauma. Can we protect patients with blunt abdominal trauma from surgery?

Year 2021, , 295 - 299, 21.05.2021

Murat Baki Yıldırım , İbrahim Tayfun Şahiner , Murat Kendirci , Bulut Özkan , Murathan Erkent , Ramazan Topcu , Settar Bostanoğlu

https://doi.org/10.32322/jhsm.896899

Abstract

Abstract
Backgrounds
Abdominal traumas have an important place in the emergency room. The two organs that are most injured in blunt abdominal trauma are the liver and spleen. Historically, surgical intervention was adopted as a treatment method for liver and spleen traumas. However, with the development of imaging methods, the possibility of non-surgical follow-up was obtained. In this study, the advantages and disadvantages of conservative treatment for surgical intervention were investigated.
Methods
The patients with complaints of blunt abdominal trauma, who were admitted to the third step research center emergency service during the 27-month period and were referred to general surgery, were retrospectively examined. The demographic data of the patients, the degree of injured organs, treatment methods and hospitalization duration were obtained by file screening. The frequency, minimum, maximum, average, and standard deviation were obtained for parametric data. A total of 91 patients were included in the study.
Results
Of patients, 58,2% (n = 53) was monitored conservatively, 34,1% (n = 31) had splenectomy and 4,4% (n = 4) underwent the primary repair due to isolated liver injury, and both splenectomy and liver primary repair were performed in 3.3% (n = 3) because of multiple solid organ injury. We observed that the injuries of non-surgical spleen trauma patients changed between grade I and III. All patients with grade IV-V injuries underwent splenectomy. However, the patients, who had a decrease in hematocrit in their follow-up and whose hematocrit did not rise despite erythrocyte replacement, were operated.
Conclusions
Medical monitoring protects patients from complications brought by surgery but poses a risk for delayed rupture of the spleen. In this study, patients with non-surgical follow up were not required to undergo surgery. The success rate of the patients with grade IV-V liver laceration was reported before as 60-70% in non-surgical follow-up. In this study, it is cleared that both liver trauma and spleen trauma should be given a chance to be followed up without surgery.

Keywords

Blunt, trauma, non-operatif management, liver, spleen

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