Evaluate the outcome of non operative management in blunt trauma abdominal solid organ injury

Background: Blunt trauma abdomen most commonly caused by road traffic accidents. Other causes are from fall from height, assault with blunt objects, bomb blast etc. The rapid deceleration cause the shearing force to tear tissues at interfaces between tissues that are relatively fixed compared to surrounding structures or crush the tissues between external force and vertebral column or rapidly raise the intra-abdominal pressure from external compression causing rupture of hollow organs1. The advent of newer imaging techniques such as CT has enabled the clinicians to diagnose the extent of injuries.These are generally managed surgically but nowadays shifting to selective NON OPERATIVE MANAGEMENT(NOM) of abdominal solid organ injuries has become the new trend in field of trauma. This NOM approach is based on outcome of retrospective studies that show decreased failure rate2.
Methods: A total of 50 cases above 18 years of age with blunt trauma abdomen who are hemodynamically stable presenting in MGMCH, Jaipur were included in study. Patients were assessed according to ATLS protocol and CECT of the abdomen was done. Patients were admitted to ICU for monitoring. If any fall in parameters of patient was observed patient was labelled as converted and emergency laparotomy was done.
Result: Those patients who responded to resuscitation in ICU were managed by Non operative management whereas remaining underwent laparotomy. Parameters for conversion was Hb <8gm/dl, hypotension, persistent fever.
Discussion: According to our study liver was the best preserved organ by Non operative management and had least rate of conversion. Non operative management was better modality of treatment without lesser complications.
Conclusion: Blunt trauma patients are best managed by Non operative management with lesser complications due to advanced critical care and higher antibiotics.