Discriminative value of conservative management of blunt abdominal trauma
Ramadan Mahmoud Ahmed AbouAhmed;
Abstract
Blunt abdominal injuries are present in most cases of multiply injured patients and represent the most common type of abdominal trauma.
Early identification of significant intra-abdominal injuries is necessary for the successful management of blunt abdominal trauma, because delay in diagnosis can lead to significant morbidity and mortality.
The key determinant for the choice of the appropriate investigation or management of solid organ injuries following blunt abdominal trauma is the hemodynamic stability of the patient .
Patients who are unstable with positive DPL require a laparotomy, while in the haemodynamically stable patients, CT is the investigation of choice.
There has been an evolution in our understanding of the importance of CT findings in patients, who have undergone blunt abdominal trauma. Although therapeutic decisions cannot be based on radiologic findings alone, but always depend primarily on clinical parameters and any concomitant extra-abdominal injuries, the information provided by CT at admission may greatly facilitate patient management.
CT-based grades of liver and splenic injuries made it possible to predict the outcome of conservative management.
Abdominal ultrasonography has proved to be of little value in deciding the possibility of conservative treatment due to inability to detect the grade of solid organ injury.
Solid organ injuries graded from I-III in haemodynamically stable patients are expected to benefit from conservative management, thus minimizing the morbidity and mortality associated with un-necessary non-therapeutic laparotomies in multiply injured patients.
Conservative treatment in a circulatory-stable multiply injured patient is the standard.
Early identification of significant intra-abdominal injuries is necessary for the successful management of blunt abdominal trauma, because delay in diagnosis can lead to significant morbidity and mortality.
The key determinant for the choice of the appropriate investigation or management of solid organ injuries following blunt abdominal trauma is the hemodynamic stability of the patient .
Patients who are unstable with positive DPL require a laparotomy, while in the haemodynamically stable patients, CT is the investigation of choice.
There has been an evolution in our understanding of the importance of CT findings in patients, who have undergone blunt abdominal trauma. Although therapeutic decisions cannot be based on radiologic findings alone, but always depend primarily on clinical parameters and any concomitant extra-abdominal injuries, the information provided by CT at admission may greatly facilitate patient management.
CT-based grades of liver and splenic injuries made it possible to predict the outcome of conservative management.
Abdominal ultrasonography has proved to be of little value in deciding the possibility of conservative treatment due to inability to detect the grade of solid organ injury.
Solid organ injuries graded from I-III in haemodynamically stable patients are expected to benefit from conservative management, thus minimizing the morbidity and mortality associated with un-necessary non-therapeutic laparotomies in multiply injured patients.
Conservative treatment in a circulatory-stable multiply injured patient is the standard.
Other data
| Title | Discriminative value of conservative management of blunt abdominal trauma | Other Titles | العلاج التحقظى لاصابات البطن الرضيه | Authors | Ramadan Mahmoud Ahmed AbouAhmed | Issue Date | 2015 |
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