Conservative therapy for blunt abdominal and thoracic traumas

Abstract

Blunt thoracic and abdominal traumas in adult, are responsible for a remarkable number of admissions in our Clinic. The aim of this study is to establish the criteria for the nonsurgical treatment in such traumas. During the period January 1993–September 1997, 7000 patients with blunt abdominal or thoracic traumas were delivered to the emergency department of our Hospital. 1200 of them were hospitalized. This number of admissions represent the 15% of all admissions in our Hospital during the same period. The mean age was 36 ± 5 years (range: 22–64 years) whereas the mean hospitalization period was 7 ± 2 days (range: 4–10 days). The most common causes were the car and motor vehicle accidents, the falls and the fights. 75 patients (6.25%) underwent surgical treatment. In 198 cases (16.6%) the traumas concerned the spleen, in 167 (13.9%) the liver, in 172 (14.3%) the injury had to do with the spleen and the liver, in 183 cases (15.25%) the trauma concerned the genitourinary system and in 215 cases (17.9%) the chest was injured. The rest 265 cases were minor trauma of the abdomen or the chest. All patients had a very closed clinical observation with careful physical examination, adequate radiographic studies (X-ray of the chest, ultrasonography, computed tomography) and blood analysis for baseline chemistries, complete blood count, PT, APTT and amylase. Peritoneal lavage was performed in all cases of abdominal tenderness. Splenectomy was performed in 31 cases, haemostasis of the liver in 35 cases, nephrectomy in 14 cases and placement of a ureteral double-J stent in 18 cases. Only 7% (84 cases) of the thoracic blunt traumas required surgical treatment. It seems that the conservative therapy of the blunt abdominal and thoracic traumas by the careful clinical surveillance, the use of ultrasonography and computed tomography, is a safe alternative method of approaching and treating such type of injuries.