Künt Karın Travmasına Bağlı Solid Organ Yaralanmalarında Non operatif Tedavi-Dalak Yaralanmaları

Abstract

Introduction: Non-operative management (NOM) is the current approach in patients with solid organ injury caused by blunt abdominal trauma. In recent years, conservative treatment is successfully employed by advances in imaging modalities, interventional radiology and intensive care management. However, there is no consensus on follow-up of trauma patients undergoing NOM. In this study, we aimed to highlight controversial issues in trauma patients undergoing NOM. Materials and methods: In this study, we retrospectively assessed with splenic injury after blunt abdominal trauma. Criteria for conversion to laparotomy include hemodynamic instability despite adequate resuscitation and presence of peritoneal irritation findings. The patients were classified as those with NOM success and those with NOM failure requiring laparotomy. Groups were compared regarding demographic characteristics, mechanism of injury, additional trauma, hemodynamic status at admission, severity of injury on CT scan, transfusion need for blood and blood products, need for laparotomy, length of hospital stay, need for ICU admission, change in hemoglobin/hematocrit value and leukocyte count, and initiation time of oral intake Results: In 72 cases with splenic injury after blunt abdominal trauma that was managed by NOM. In 10 patients, NOM was failed and the patients underwent laparotomy. All patients underwent CT scan during initial diagnostic workshop. Conclusion: Imaging modalities should be used in the follow-up of patients with ≥grade 3 injury. Higher grades of injury result in increased costs and prolonged hospitalization. NOM failure is increased in high grade injuries. Another factor in NOM failure is perforation of non-solid organs. Close hemodynamic monitorization, frequent physical examination and effective fluid resuscitation are essential in patients undergoing NOM. It should be kept in mind that complications such as re-bleeding and splenic abscess may occur at early period after discharge.