Conservative Management Of Blunt Trauma Research Articles

Non operative conservative management of blunt trauma to the spleen in Children: A Single Tertiary Hospital Experience

Background: Splenic injury is the leading cause of major bleeding in the patients of blunt abdominal trauma. In earlier medical practice, the blunt splenic injury was managed surgically in most cases, but the increased understanding of the splenic function in the immunological process and the identification of post-splenectomy complications have led physicians to prefer the non-operative management . Material and methods: A retrospective study of the patients with blunt trauma to the spleen in the pediatric age group between the year 2015 and 2018. The study was conducted in (Nasser Institute Hospital for research and treatment). Management of the patients was done using hypovolemic resuscitation and serial follow up. Abdominal ultrasound, complete blood picture and Abdominal CT were done. Data was tabled and analyzed. Results: A total of 123 blunt splenic trauma patients were identified. Traffic-related accident and falling from height were the main mechanisms of injury. Splenic contusion and hematoma were the most frequent finding on initial computerized tomography (CT) scans, followed by shattered spleen, blush, and devascularization. Non-operative management failed in 6 patients who underwent splenectomy. (95.12%) of the patients managed successfully using hypovolemic resuscitation without need for surgical interference. Discussion: Non-operative management is considered for patients with low-grade splenic injuries, unless operated upon for other associated injuries. In fact, higher-grade injuries could also be managed non-operatively. Splenic angioembolization of bleeding vessels increased the success rate of non-operative management in hemodynamically stable patients. In our study, although we didn`t use splenic angioembolization we were able to reach high rates of success. In comparison with the operative management of blunt splenic trauma, the nonoperative management has the added benefit of preserving the splenic functions. Conclusions: Most blunt splenic trauma patients were successfully treated non-operatively, with a low failure rate. The severity of injury and presence of associated lesions should be carefully considered in developing the management plan.

Non operative conservative management of blunt trauma to the spleen in Children: A Single Tertiary Hospital Experience

Non operative conservative management of blunt trauma to the spleen in Children: A Single Tertiary Hospital Experience

Treatment in Pediatric Renal Trauma: A Conservative Management Approach

Purpose: The management of pediatric trauma is substantially derived from the results of adult trauma patient. Despite the increasing of pediatric renal trauma, the management of them still remains controversial. The aim of this study is to evaluate our experience with the expectant conservative management of blunt trauma in children. Materials and Methods: We retrospectively studied 45 pediatric patients with renal trauma between 1995 and 2007. We reviewed medical records for clinical symptoms, mechanism of injury, assigned grade of renal injury, associated injuries, indication of surgery, and treatment outcomes. We graded renal injuries according to the American Association for the Surgery of Trauma Organ Injury Scale. Results: All patients of grade I, II, III, and IV were managed conservatively at beginning, if the hemodynamic state is stable. Among them, 2 patients of grade IV were done delayed operation. One patient underwent delayed renorrhaphy for persistent anemia and hypotension, and the other patient needed delayed nephrectomy because of persistent fever and worsening abdominal pain with significant urinary extravasation. All patients of grade V were undergone early nephrectomy. Conclusions: Except for persistent fever with significant extravasation and grade V injury, initial conservative management of blunt renal trauma in children is effective and recommendable at beginning, if the hemodynamic state is stable. Prospective larger randomized controlled trials will be needed. (Korean J Urol 2009;50:1125-1132) 󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏