Abstract
BackgroundIn recent years there has been increasing interest shown in the nonoperative management (NOM) of blunt traumatic injury. The growing use of NOM for blunt abdominal organ injury has been made possible because of the progress made in the quality and availability of the multidetector computed tomography (MDCT) scan and the development of minimally invasive intervention options such as angioembolization.AimThe purpose of this review is to describe the changes that have been made over the past decades in the management of blunt trauma to the liver, spleen and kidney.ResultsThe management of blunt abdominal injury has changed considerably. Focused assessment with sonography for trauma (FAST) examination has replaced diagnostic peritoneal lavage as diagnostic modality in the primary survey. MDCT scanning with intravenous contrast is now the gold standard diagnostic modality in hemodynamically stable patients with intra-abdominal fluid detected with FAST. One of the current discussions in the literature is whether a whole body MDCT survey should be implemented in the primary survey. ConclusionsThe progress in imaging techniques has contributed to NOM being currently the treatment of choice for hemodynamically stable patients. Angioembolization can be used as an adjunct to NOM and has increased the success rate to 95%. However, to date many controversies exist about the optimum patient selection for NOM, the proper role of angioembolization in NOM, the best technique and material to use in angioembolization, and the right follow-up strategy of patients sustaining blunt abdominal injury. Conducting a well-designed prospective clinical trial or a Delphi study would be preferable.
Highlights
Trauma is the leading cause of death among people who are younger than 45 years [1]
The turning point of this van der Vlies et al International Journal of Emergency Medicine 2011, 4:47 http://www.intjem.com/content/4/1/47 management style came with the introduction of the Advanced Trauma Life Support (ATLS) principles by Steiner and Collicott in 1978 [3]
Multidetector computed tomography (MDCT) scanning with intravenous contrast is the gold standard diagnostic modality in hemodynamically stable patients with intra-abdominal fluid detected with FAST
Summary
Trauma is the leading cause of death among people who are younger than 45 years [1]. One of the main causes of death after trauma, with numbers ranging from 40 to 80%, is exsanguination caused by injuries to the abdominal organs.The spleen and liver are the most commonly injured organs as a result of blunt trauma [2]. Trauma is the leading cause of death among people who are younger than 45 years [1]. One of the main causes of death after trauma, with numbers ranging from 40 to 80%, is exsanguination caused by injuries to the abdominal organs. The spleen and liver are the most commonly injured organs as a result of blunt trauma [2]. Over the past 40 years, many changes in the primary survey and treatment of patients with blunt abdominal. In recent years there has been increasing interest shown in the nonoperative management (NOM) of blunt traumatic injury. The growing use of NOM for blunt abdominal organ injury has been made possible because of the progress made in the quality and availability of the multidetector computed tomography (MDCT) scan and the development of minimally invasive intervention options such as angioembolization
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