The efficacy and safety of non operative management in abdominal injury in a high volume but resource stretched setting

Authors

  • Angeline Neetha Radjou Pondicherry Institute of Medical Sciences, Puducherry
  • Jayakumar Paramsivam Sri Lakshmi Narayana Institute of medical sciences, Puducherry
  • Mohan Kumar S. Indira Gandhi Government general hospital and post graduate institute, Puducherry

DOI:

https://doi.org/10.18203/2349-2902.isj20151074

Keywords:

Abdominal trauma, Non Operative Management, Damage control, Missed injuries, Hepatoportal fistula, Chylous ascites

Abstract

Background:Injury to the abdomen is a significant cause of mortality and morbidity. The study was to describe the clinical profile and analyse the efficacy and safety of Non Operative Management (NOM) in a high volume but resource stretched setting.

Methods: A prospective observational study was conducted on patients with abdominal injury. The clinical profile; interventions, morbidity and mortality were studied.

Results:Of the 130 cases of serious injury to the abdomen, 16 patients died during resuscitation,52 were taken up for immediate laprotomy due to hemodynamic instability/peritonitis and 62 patients were initially managed by NOM. The failure rate in NOM was 34% mainly due to delayed manifestations of bowel injury. However the mortality rate directly attributable to missed bowel injury was 2 %.

Conclusions:Injury to the abdomen is one of the leading causes of morbidity and mortality. The efficacy and safety of NOM in our facility is comparable to published validated studies. The mortality rate directly attributable to missed bowel injury was 2 %, is acceptable to avoid the 50% chance of negative/non therapeutic laprotomy. We have identified a few red herrings in our study ,which could further increase safety, in our high volume but resource stretched setting.

References

Burch JM, Franciose RJ, Moore EE. Trauma. In: Brunucardi FC, editor. Principles of surgery. NewYork: McGraw Hill; 2005;2:129-87.

Como JJ, Bokhari F, Chiu WC, Duane TM, Holevar MR, Tandoh MA, et al. Practice management guidelines for selective nonoperative management of penetrating abdominal trauma. J Trauma. 2010;68:721-33.

Wohlgemut JM, Jansen JO. The principles of non-operative management of penetrating abdominal injury. Trauma. 2013;15:289-300.

Velmahos GC. Non operative treatment of solid organ injury. Arch Surg. 2003;138:844-51.

Moore EE, Malangoni MA, Cogbill TH, Shackford SR, Champion HR, Jurkovich GJ, et al. Organ injury scaling IV: Thoracic vascular, lung, cardiac and diaphragm. J Trauma. 1994;36:299-300.

Raza M, Abbas Y, Devi V, Prasad KVS, Rizk KN. Non operative management of abdominal trauma – a 10 years review. World Journal of Emergency Surgery. 2013;8:14.

Mohapatra S, Pattanayak SP, Rao KRRM, Bastia B. Options in the management of solid visceral injuries from blunt abdominal trauma. Indian J Surg 2003;65:263-8.

Clarke JR, Trooskin SZ, Doshi PJ, Greenwald L, Mode CJ. Time to laparotomy for intra-abdominal bleeding fromtrauma does affect survival for delays up to 90 minutes. J Trauma. 2002;52:420-5.

Carlos V. R. Brown .George C. Velmahos,Angela L. Neville, Peter Rhee, AliSalim, BurapatSangthong, DemetriosDemetriades.Identifying Those Who Are Bleeding Arch Surg. 2005;140:767-772

Lund H, Kofoed SC, Hillingsø JG, Falck-Larsen C, Svendsen LB. High mortality after emergency room laparotomy in haemodynamically unstable trauma patients. Dan Med Bull. 2011;58:A4275.

Jeremy M Hsu and Tam N Pham.Damagecontro; in the injured patient.Int J CritIlln Inj Sci. 2011;1:66-72.

Pfeifer R, Tarkin IS, Rocos B, Pape HC. Patterns ofmortality and causes of death in polytrauma patients-has anything changed? Injury. 2009;40:907-11.

Banz VM, Butt MU, Zimmermann H, Jeger V, and Aristomenis K Exadaktylos. Free abdominal fluid without obvious solid organ injury upon CT imaging: an actual problem or simply over-diagnosing?J Trauma Manag Outcomes.2009; 3: 10.PMCID: PMC2805600

M Heuer, G Taeger, Kaiser GM, Nast-Kolb D, Kühne CA, Ruchholtz S, et al. No further incidence of sepsis after splenectomy for severe trauma: a multi-institutional experience of the trauma registry of the DGU with 1,630 patients. Eur J Med Res. 2010;15(6):258-65.

Nast-Kolb D, Waydhas C, Kastl S, Duswald KH, Schweiberer L. The role of an abdominal injury in follow-up of polytrauma patients. Chirurg. 1993;64:552-9.

Karamercan A, Yilmaz TU, Karamercan MA, Aytaç B. Blunt abdominal trauma: evaluation of diagnostic options and surgical outcomes. Ulus Travma Acil Cerrahi Derg. 2008;14(3):205-10.

Niederee MJ, Byrnes MC, Helmer SD, Smith RS. Delay in diagnosis of hollow viscus injuries: effect on outcome. Am Surg. 2003;69:293-8.

McNutt MK, Chinapuvvula NR, Beckmann NM, Camp EA, Pommerening MJ, Laney RW, et al. Early surgical intervention for blunt bowel injury: The Bowel Injury Prediction Score (BIPS). J Trauma Acute Care Surg. 2015;78(1):105-11.

Wotherspoon S, Chu K, Brown AF. Abdominal injury and the seat-belt sign. Emerg Med. 2001;13:61-5.

McIntyre LK, Schiff M, Jurkovich GJ. Failure of nonoperative management of splenic injuries: causes and consequences. Arch Surg. 2005;140:563-8.

Guillon F. CT of the acute abdomen, Medical Radiology, Diagnostic imaging 2010 Springer-Verlag berlin Heidelberg. 2011:16.

Peitzman AB. Splenic injury in adults: variability in practice and adverse consequences J Am Coll Surg. 2005;201:179-87.

Root HD. Splenic injury: angiogramvs operation. J Trauma. 2007;62(6 Suppl):S27.

Rai RS, Singh SK, Mandal AK, Mete UK, Goswami AK, Sharma SK. Review of 48 consecutive cases of renal injury: Outcome of management by conservative vs operative approach. Indian J Urol. 2004;20:113-7.

Hsee L, Civil I. Management of low-velocity, non-gunshot-wound penetrating abdominal injury: have we moved with the times? N Z Med J. 2008;121:26-31.

Jansen JO, Inaba K, Rizoli SB, et al. Selectivenon-operative management of penetrating abdominalinjury in Great Britain and Ireland: Survey ofpractice. Injury. 2012;43:1799-804.

Padalino P, Bomben F, Chiara O, Montagnolo G, Marini A, Zago M, et al. Healing of Blunt Liver Injury AfterNon-Operative Management: Role of Ultrasonography Follow-up. Eur J Trauma Emerg Surg. 2009;35:364-70.

Leibovitch I1, Mor Y, Golomb J, Ramon JThe diagnosis and management of postoperative chylous ascites. J Urol. 2002;167(2 Pt 1):449-57.

Bulinski P1, Bachulis B, Naylor DF Jr, Kam D, Carey M, Dean RE. The changing face of trauma management and its impact on surgical resident training. J Trauma. 2003;54(1):161-3.

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Published

2016-12-14

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Original Research Articles