Management Of Abdominal Trauma Research Articles

Abdominal trauma: Clinical monitoring, an overlooked yet essential ally

Abdominal traumas are a frequent emergency and are associated with significant morbidity and mortality in spite of improved recongnition, diagnosis and management. Trauma is the second largest cause of disease accounting for 16% of global burden. Approach to trauma should be systemic and prioritized. The hemodynamically unstable patient should undergo expedient sonography to rule out abdominal haemorrhage. The use of computer tomography (CT) in this difficult patient group is also currently evaluated; however it takes specific amendments to the protocol and institution. In the hemodynamically stable patient however, computed tomography is the modality of choice to evaluate the injured abdomen. Non operative treatment can be successful in up to 80% of selected cases. This article objective the interest of close monitoring in the management of abdominal trauma, this monitoring reduces the rate of surgical intervention in clinically stable patients and also allows to propose a delayed surgery if the patient’s clinical or radiological status changes during monitoring.

Laparoscopy versus laparotomy in the management of abdominal trauma

AbstractObjectiveThe objective of this study was to compare, evaluate and manage abdominal trauma using two distinct surgical techniques: laparoscopy and laparotomy. The aim was to assess the effectiveness and safety of laparoscopic procedures compared with laparotomy for treating penetrating or blunt abdominal trauma.MethodologyIn this prospective comparative study, we recruited 60 patients clinically diagnosed with abdominal trauma. The research was conducted at the Emergency Unit of the Department of General Surgery, Faculty of Medicine, Aswan University Hospital. All participants provided signed informed consent before their inclusion in the study.ResultsThere was a significant statistical difference between the two groups in terms of the operation duration, length of stay in the intensive care unit post‐operatively, occurrence of gas passage and duration of hospitalisation.ConclusionsLaparoscopic surgical procedures present a viable and practical alternative to laparotomy in appropriate cases for patients. The decision to choose laparoscopy as a surgical approach should depend on the surgeon's proficiency and the availability of required resources.

Comparison of Clinical Characteristics, Therapy, and Short-Term Prognosis between Blunt and Penetrating Abdominal Trauma: A Multicentric Retrospective Cohort Study.

Large-scale studies on the characteristics and management of abdominal trauma in megacities in China are lacking. The aim of this study was to analyze and present the clinical patterns and treatment status of abdominal trauma in regional medical centers. Cases of abdominal trauma treated at seven medical centers in Beijing from 2010 to 2021 were collected. Clinical information about age, sex, injury cause, geographic distribution, abbreviated injury scale/injury severity score (AIS/ISS) value, injury-hospital time, preoperative time, surgically identified organ injuries, type of surgery, causes of reoperation and 90-day mortality was included in this study. Clinical characteristics, treatment methods, and short-term prognoses (90-days survival) were compared between blunt abdominal trauma (BAT) and penetrating abdominal trauma (PAT) cases. Non-normally distributed data are described as medians (IQR), and the Mann‒Whitney U test was performed; qualitative data were analyzed using the X2 test. Univariate and multivariate survival analyses were performed by the Cox proportional hazards model. A total of 553 patients (86.98% male) with a median age of 36.50 (27.00-48.00) years were included. The BAT group had a significantly higher proportion of serious injury (P=0.001), lower initial hemoglobin level (P=0.001), and a lower laparoscopy surgery rate (P=0.044) compared to the PAT group. Additionally, more BAT cases were from the area around Beijing (P=0.008) and a longer injury-regional hospital time (10.47 (5.18-22.51) hours vs. 7.00 (3.80-15.38) hours, P=0.001). In the hollow viscus injury subgroup, the BAT group had a significantly longer injury-regional hospital time and preoperative time compared to the PAT group (injury-regional hospital time: 10.23 (6.00-21.59) hours vs. 7.07 (3.99-13.85) hours, P=0.002; preoperative time: 3.02 (2.01-5.58) hours vs. 2.81 (1.85-3.63) hours, P=0.047). The overall 90-day mortality was 11.9%, and longer injury-regional hospital time (HR: 1.01, 95% CI: 1.00-1.02, P=0.008), receipt of ICU treatment (HR: 4.69, 95% CI: 2.54-8.65, P=0.001), and severe ISSs (ISS > 25 vs. ISS < 16, HR: 2.78, 95% CI: 1.38-5.601, P=0.004) had a worse impact on survival. More patients with BAT were transferred to higher-level hospital, leading to significantly longer prehospital and preoperation time. In the subgroup of hemodynamically stable individuals, more patients with BAT experienced hollow viscus injuries. For those patients, aggressive diagnostic laparoscopic exploration may be beneficial. Patients with longer injury-regional hospital intervals, the need for ICU care, and higher injury severity scores (ISSs) suffered from worse prognoses.

Repeat imaging increases detection of delayed pseudoaneurysms in patients with high-grade solid organ injury following abdominal trauma.

Nonoperative management of abdominal trauma can be complicated by the development of delayed pseudoaneurysms. Early intervention reduces the risk of rupture and decreases mortality. The objective of this study is to determine the utility of repeat computed tomography (CT) imaging in detecting delayed pseudoaneurysms in patients with abdominal solid organ injury. A retrospective cohort study reviewing Montreal General Hospital registry between 2013 and 2019. Patients with The American Association for the Surgery of Trauma (AAST) grade 3 or higher solid organ injury following abdominal trauma were identified. A chart review was completed, and demographics, mechanism of injury, Injury Severity Score (ISS) score, AAST injury grade, CT imaging reports, and interventions were collected. Descriptive analysis and logistic regression model were completed. We identified 195 patients with 214 solid organ injuries. The average age was 38.6years; 28.2% were female, 90.3% had blunt trauma, and 9.7% had penetrating trauma. The average ISS score was 25.4 (SD 12.8) in patients without pseudoaneurysms and 19.5 (SD 8.6) in those who subsequently developed pseudoaneurysms. The initial management was nonoperative in 57.0% of the patients; 30.4% had initial angioembolization, and 12.6% went to the operating room. Of the cohort, 11.7% had pseudoaneurysms detected on repeat CT imaging within 72h. Grade 3 represents the majority of the injuries at 68.0%. The majority of these patients underwent angioembolization. In patients with high-grade solid organ injury following abdominal trauma, repeat CT imaging within 72h enabled the detection of delayed development of pseudoaneurysms in 11.7% of injuries. The majority of the patients were asymptomatic.

Multifunctional Cationic Hyperbranched Polyaminoglycosides that Target Multiple Mediators for Severe Abdominal Trauma Management.

Trauma and its associated complications, including dysregulated inflammatory responses, severe infection, and disseminated intravascular coagulation (DIC), continue to pose lethal threats worldwide. Following injury, cell-free nucleic acids (cfNAs), categorized as damage-associated molecular patterns (DAMPs), are released from dying or dead cells, triggering local and systemic inflammatory responses and coagulation abnormalities that worsen disease progression. Harnessing cfNA scavenging strategies with biomaterials has emerged as a promising approach for treating posttrauma systemic inflammation. In this study, the effectiveness of cationic hyperbranched polyaminoglycosides derived from tobramycin (HPT) and disulfide-included HPT (ss-HPT) in scavenging cfNAs to mitigate posttrauma inflammation and hypercoagulation is investigated. Both cationic polymers demonstrate the ability to suppress DAMP-induced toll-like receptor (TLR) activation, inflammatory cytokine secretion, and hypercoagulation by efficiently scavenging cfNAs. Additionally, HPT and ss-HPT exhibit potent antibacterial efficacy attributed to the presence of tobramycin in their chemical composition. Furthermore, HPT and ss-HPT exhibit favorable modulatory effects on inflammation and therapeutic outcomes in a cecal ligation puncture (CLP) mouse abdominal trauma model. Notably, in vivo studies reveal that ss-HPT displayed high accumulation and retention in injured organs of traumatized mice while maintaining a higher biodegradation rate in healthy mice, contrasting with findings for HPT. Thus, functionalized ss-HPT, a bioreducible polyaminoglycoside, holds promise as an effective option to enhance therapeutic outcomes for trauma patients by alleviating posttrauma inflammation and coagulation complications.

Introduction of Laparoscopy in an Urban High-Volume Sub-Saharan Trauma Centre

IntroductionTrauma is a major disease burden in low and middle-income countries like South Africa. Abdominal trauma is one of the leading reasons for emergency surgery. The standard of care for these patients is a laparotomy. In selected trauma patients, laparoscopy has both diagnostic and therapeutic usage. The trauma burden and the number of cases seen in a busy trauma unit make laparoscopy challenging.AimWe wanted to describe our journey with laparoscopy in the management of abdominal trauma in a busy urban trauma unit in Johannesburg, South Africa.MethodsWe reviewed all trauma patients who underwent diagnostic laparoscopy (DL) or therapeutic laparoscopy (TL) between 01 January 2017 and 31 October 2020 for blunt and penetrating abdominal trauma. The demographic data, indications for laparoscopy, injuries identified, procedures performed, intraoperative laparoscopic complications, conversion to laparotomy, morbidity, and mortality were evaluated.ResultsA total of 54 patients who had laparoscopy were included in the study. The median age was 29 years (IQR 25–25). Most injuries were penetrating 85.2% (n = 46/54) and 14.8% blunt trauma. Most patients were males, 94.4% (n = 51/54). Indications for laparoscopy included diaphragm evaluation (40.7%), pneumoperitoneum for evaluation of potential bowel injury (16.7%), free fluid with no evidence of solid organ injury (12.9%) and colostomy (5.5%). There were 8 (14.8%) cases converted to laparotomy. There were no missed injuries or mortality in the study group.ConclusionLaparoscopy in selected trauma patients is safe even in a busy trauma unit. It is associated with less morbidity and shortened hospital length of stay.

Jean Baptiste Lucien Bauden's Clinique des Plaies D'Armes a Feu: The First English Translation of the First Trauma Laparotomy.

Historically, abdominal trauma was managed nonoperatively with rest and local wound cares. Jean Baptiste Lucien Baudens (1804-1857) was a French military surgeon and performed the first 2 trauma laparotomies. The first patient died but the second survived. Laparotomy in trauma has since evolved, now a life-saving intervention and a fundamental tool in the management of abdominal trauma. Baudens documented these case reports in his 1836 work Clinical Reports of Gun Wounds (Clinique des Plaies D'Armes a Feu). The work of Baudens has been largely unrecognized and underappreciated in the English literature. This manuscript serves as the first translation of this event.

Telemedicine for the Surgical Management of Abdominal Trauma in the District Hospitals

The outcomes of the 51 patients with blunt abdominal trauma after the car crash treated in the district hospital were analyzed. 25 patients in a basic group, underwent surgery during which the distant specialist consultation was led via Telemedicine. Telemedicine allowed the specialist surgeon clearly evaluate the degree of the spleen injury and give a suggestion to conduct the organ-preserved operation. In a control group, patients with spleen injury underwent the conventional splenectomy. The short- and long-term outcomes in the basic group were better than in the control group. Telemedicine served as a good tool for performing organ-preserved surgeries in the district hospital and improving the outcomes of patients with intra-abdominal hemorrhage.

Management of abdominal Trauma at Al-Gamhouria General Modern Hospital-Aden-Yemen

Abdominal injury is relatively common in both civilian and military casualties and isa leading cause of morbidity and mortality. The aim of this study is to identify the prevalence of abdominal traumaو to evaluate its impact on the intraperitoneal and Retroperitoneum organs, and to evaluate various modalities of management and its outcome.&#x0D; This is a prospective study conducted at Al-Gamhouria Modern General Hospital, from 1stJanuary 2013 up to 31stDecember 2014. This study involved 70 patients whowerediagnosed as abdominal trauma and admitted to the hospital during the study period. Data were collectedfrom the patients by their clinical history, examination and appropriate investigations. Male patients were predominantly more than female, 65 (92.9%) vs.5 (7.1%). Abdominal trauma involved young people with the mean age of31.3 ± 13.9 years; most of them were from Aden. Penetrating injuries were more prevalent compared to blunt injuries, as the mode of injury was mostly due to gunshots. The most frequently injured abdominal organ was small bowel.Complications occurred in 25(35.7%) patients. Woundinfection was the most common complications.Operative intervention was the treatmentoption for most patients with abdominal trauma.

Study of Treatment Modalities for Blunt Abdominal Trauma and its Medicolegal Aspect

Background: Blunt abdominal trauma management has changed drastically from surgical to conservative. In ourstudy we analyzed 100 patients visited hospital with blunt abdominal trauma and diagnostic and managementmodalities and medicolegal aspect are discussed.Study evaluate the incidence and clinical presentation, various available investigations, the organs affected inblunt abdominal trauma and management of complications, morbidity and mortality following blunt abdominalinjury.To handle such cases to save the patient and our self from litigation.Material and methods: This study consists an analysis of randomly selected 100 cases with blunt abdominaltrauma admitted during the period of May 2018 to August 2020. It is a prospective observational study.Conclusion: Blunt abdominal trauma is on rise due to excessive use of motor vehicles. From our study weconcluded that single solid organ injury patients with hemodynamic stability (specially Grade 1 to grade 3)managed conservatively more compared to multiple solid organ injury patients and best investigated by USGFAST and CT scan.Careful record keeping can assist to protect against bogus and false allegations and complaints,as in court of law documentation is considered as part of witness.

Prospective study on role of E-FAST in evaluation of abdominal trauma

Introduction: Diagnosis of abdominal trauma is a real challenge that helps the treating doctor in optimum management of abdominal trauma which include Diagnostic peritoneal lavage (DPL), Extended-Focused Assessment with Sonography for Trauma (FAST) and CT scan. Objectives: The aim of this study is to define the recent role of E-FAST in the diagnosis of abdominal trauma. Material and methods: Aim of the study is to evaluate patients coming to the department of Radiodiagnosis of Dhiraj General hospital with USG. Total number of patients are 50. Results: Out of 50 patients of abdominal trauma, 9 patients (22%) were in age group 21-30 years the commonest mode of trauma was road accident according for 54% of total cases. In this study, more commonly injured organs are liver, spleen and kidney. USG showed overall sensitivity 57.48% and specificity 97.77%. Conclusion: E-FAST is useful as the initial diagnostic tool for abdominal trauma. With proper training and understanding limitations of ultrasound, the results of E-FAST can be optimized.

Lessons learned from blunt trauma abdomen: Surgical experience in level I trauma centre.

The number of accident cases is increasing day by day, so as the challenges. With an emphasis on trauma care, the government started a 120 bedded level I trauma centre in northern India catering to a population of 2.8 million in June 2018. Through this article, we aimed to share our experience of blunt abdominal trauma management from a new level I trauma centre. In this retrospective observational study, historical analysis of all available records from July 2018 to March 2020 was done. Inclusion criteria included blunt trauma abdomen with or without associated injuries. Data regarding age, sex, mechanism of injury, time taken to reach the hospital, the pattern of solid organs and hollow viscus injuries, associated extra abdominal injuries, mode of treatment, complications, length of ICU and hospital stay, and mortality were reviewed. Overall, 154 cases sustained abdominal injuries during the study period. Seventy-five percent were male. The most common cause of blunt trauma abdomen was road traffic crashes. Operative management was required in 57 (37.01%) cases while 97(62.98%) were managed non-operatively (NOM). Mean ICU stay was 05.73 days, while the average hospital stay was 12 days (range 10-60 days). Procedures performed included splenectomy, liver repair, primary closure of bowel injury, and stoma formation. Complications occured in 16.88% cases and the overall mortality rate was 11.68%. The study revealed that among 154 cases of fatal blunt abdominal trauma, road traffic crash was the most common cause of blunt abdominal trauma, predominantly affecting males. The visceral and peritoneal injury frequently perceived was liver in 40 cases (25.9%), spleen 66 (43%), intestine 21(13.6%) and kidney 13 cases (09%). Abdominal injury was associated with other injuries like head, chest and extremity injuries in 52.5% cases. Duration of injury, presence of associated injury and preoperative ventilation requirement were independent predictors of mortality apart from contributary factors such as clinical presentation, organ involved and presence of complications.

Management of solid organ injury in patient of blunt abdominal trauma

Background: In this ongoing era of 21st century, trauma is the leading cause of death in individuals between age 1 and 44. In trauma, also road traffic accidents (RTAs) are the major cause of death. Blunt abdominal trauma is a frequent emergency and is associated with significant morbidity and mortality.Methods: A prospective analysis of 50 patients of blunt abdominal trauma admitted in SMIMER hospital Surat within a span of 12 months was done. Unstable patients with initial resuscitation underwent focused assessment sonography for trauma (FAST). Failed resuscitation with free fluid in abdomen confirmed by FAST immediately shifted to operation theatre for laparotomy and proceed. Hemodynamically stable patients underwent computerized tomography of abdomen.Results: Most of the patients in our study were in the age group of 21-45 years with M:F ratio of 4:1. RTAs (62%) was the most common mechanism of injury. Spleen (38%) was the commonest organ injured and the most common surgery performed was splenectomy. In total non-operative management (NOM) was done in 58% of cases and surgical management was done in 42% of cases.Conclusions: Appropriate patient selection, early diagnosis and repeated clinical examination and use of appropriate investigations forms the key in management of blunt abdominal trauma. To conclude, initial resuscitation measures and correct diagnosis forms the most vital part of blunt abdominal trauma management.

Epidemiology, diagnostic and management of abdominal trauma in two hospitals in the city of Douala, Cameroon

Background: Abdominal trauma remains quite common in the general world and in developing countries in particular. The accidents in the public roads are the main cause and also the assumption of responsibility which remains questionable.Methods: It was a descriptive longitudinal study, carried out from 31 December 2018 to 19 April 2019, in Laquintinie and General hospital in Douala, Cameroon. Patients admitted for abdominal trauma and treatment in the emergency department, operating theater and visceral surgery were included in the study.Results: We found 21.2% (43 cases) of abdominal trauma in our series. Abdominal trauma mainly affected adults between 20 and 39 years old (27 cases, 63%) in our series. The male sex was most affected, with sex ration of 3.3. Road accidents occupy the first place with 34.9% (15 cases). Wounds in our series represented 27.9% (12 cases) and contusions 72.1% (31 cases). In fact, Abdomen without preparation was performed in 7.0% (3 cases) of cases, abdominal ultrasound in 48.8% (21 cases) and abdominal CT scan in 25.6% of patients (11 cases). The organs affected in order were the spleen, small intestine, colon, stomach and liver. We recorded postoperative complications with a morbidity of 11.6% with a single case of parietal suppuration and no death.Conclusions: In our context abdominal trauma remains quite frequent and concern particularly young people. The prevention of accidents on the public highway and the improvement of diagnostic and surveillance methods are the key for reducing this phenomenon leading to good management.

Management of Blunt Solid Organ Injuries: the Indian Society for Trauma and Acute Care (ISTAC) Consensus Guidelines

Abdominal trauma management has seen a paradigm shift over the last few decades. There is wide variation in the treatment depending on the level of healthcare facilities available. With an aim to standardise the treatment of solid organ injuries in blunt abdominal trauma, Indian Society for Trauma and Acute Care (ISTAC®) formulated consensus guidelines to benefit doctors engaged in trauma care in the country.

Abdominal Trauma Management: About 62 Cases at the Department of General Surgery of H&amp;amp;ocirc;pital Somin&amp;#233; DOLO de Mopti, Mali

We undertook a prospective and descriptive observational study on abdominal trauma from February 1, 2016 to August 31, 2017. The aim of this work was to identify the typology and management of abdominal trauma cases in our surgery department. Overall, abdominal trauma represented 3.54% (62/1751) of all surgeries during the study period. Among the 62 cases, men accounted for 59 and women for 3. The sex ratio was 19.67. The mean age was 24 ± 15 years. Road accidents were the most represented with 43.5% of cases. The couple of signs, hypovolemic shock and abdominal pain and decrease on blood pressure were the prominent clinical symptoms with 100.0%, and 50.0% of cases, respectively. Abdominal ultrasound and abdominal x-ray without contrast were performed in 67.0% and 18.0% of cases, respectively. Abdominal trauma was divided into two entities: contusion 68% and wounds 32%. Medical treatment was sufficient in 23.00% of cases. Laparotomy as a surgical approach was performed in 77.0% of cases. Local hemostasis plus drainage (27.08%), splenectomy (25.00%), suture (14.58%), hemostasis by tamponade (8.33%) and colostomy (2.08%) were undertaken as surgical procedures when it came to deal with contusions. Debridement of wounds plus suture and hemostasis by tamponade was performed in 18.73% and 4.16 cases, respectively. The most observed lesions were those of the spleen with 27.42% and those of the small bowel with 24.19%. The postoperative follow-up was straightforward in 83.33% of cases. The overall mortality was 4.17%.

Surgical Management of Abdominal Trauma: Indications and Outcomes in Two Emergency Units with Limited Infrastructure Resources in Yaound&amp;#233; (Cameroon)

Introduction: Abdominal trauma is a major public health concern. Their management is controversial and difficult. Operative indications are not codified in all situations. Patients and Methods: This was a descriptive cross- sectional study over a period of 5 years, carried out in the surgical emergency department of the Central Hospital of Yaounde and the Emergency Centre of Yaounde. We reviewed retrospectively medical records of patients who had laparotomy after abdominal trauma. Results: We collected 115 files. There was a male predominance (83.47%) and the average age was 33.8 years. The average time to admission was 12.3 hours and the aetiologies were dominated by road traffic accidents (53%). Abdominal contusions represented 69.56% of cases and abdominal wounds 30.44% of cases. Indications for surgery were hemodynamic instability, evidence of a lesion of a hollow viscus, the presence of evisceration or a gunshot wound, and initial non-operative treatment failure. Postoperative morbidity was 9.56% and overall mortality was 3.47%. Conclusion: Surgical management of abdominal trauma is frequent in our setting, mainly indicated for hemodynamic instability. Results are good with a low morbi-mortality.

Non-Operative Management for Renal and Splenic Trauma – A Case Report

Management of abdominal trauma has evolved over the past decades and most of trauma patients can be managed conservatively. This article demonstrates the effectiveness of non-operative management (NOM) in a patient with grade IV renal trauma and grade II splenic trauma that was treated in the urology department of Emergency Clinical County Hospital of Brasov after a car crash. Clinical examination showed bruises on the right shoulder and macroscopic haematuria that suggest renal trauma. The abdomen was spontaneously painles, no signs of acute abdomen but severe pain in the left lumbar area, with no additional relevant medical history. The CT scan revealed laceration of the valvular area of the left kidney, spleen contusion and retroperitoneal haematoma with contrast spreading in the iliopsoas muscle region, classifying renal trauma as stage IV and splenic trauma as stage II on American Association for the Surgery of Trauma injury scale. The trauma is classified as serious with an Injury Severity Score of 18, and Resciniti CT score of 2, therefore NOM is recommended. Despite high grade trauma, the patient was haemodynamically stable, with a heart rate of 90 bpm, blood pressure of 105/65 mmHg and haemoglobin of 10.4g/dl. Under constant observation and with the help of a multidisciplinary team, the therapeutic focus was directed on local protocol consisting of pharmacological treatment with fluid resuscitation, antibiotic therapy, analgesics, haemostatics, anticoagulant therapy and multiple blood transfusions consisting of fresh frozen plasma and packed red blood cells. Starting with day 6, the haemoglobin levels normalized, no further blood transfusion beeing necessary. The patient was discharged and didn’t developed complications in the following 6 months. The NOM in the case of grade IV renal trauma and a grade II splenic trauma is effective, provided the patients are haemodynamically stable and constant reevaluations are performed.

Task-Sharing in Emergency Abdominal Surgery: A Retrospective, Cross-Sectional Study of Emergency Laparotomy Performed by Physicians and Emergency Surgical Officers in 6 Ethiopian Hospitals

Background: Surgical task-sharing is a strategy allowing trained mid-level providers to perform essential surgery in low-resource areas. Despite case volumes second only to obstetric surgery, no large-scale comparative study has been previously performed examining task-sharing for acute abdominal surgery. Both general surgeons and mid-level emergency surgical officers (ESOs) perform laparotomies in the same facilities in Ethiopia, presenting an opportunity for comparative analysis of outcomes. Methods: A three-year retrospective study collected surgical case data at 4 general hospitals (n = 1540) with ESOs and MD surgeons, and 2 comparison samples from a primary (n = 100) and a tertiary (n = 142) hospital. Bivariate analysis compared mortality and morbidity stratified by provider type, sub-stratified by facility and twelve categories of emergency abdominal surgery. Multivariable logistic regression modeled the impact of provider training level on odds of perioperative mortality, complication and SSI rates, adjusting for patient age, gender, hospital facility, distance score and preoperative health score. Results: Both overall and within each general hospital across 12 diagnosis categories of emergency abdominal surgery, no significant additional risk was found for ESO mortality, complication and SSI rates. Logistic regression modeling found no additional odds of mortality, complication or surgical site infection for ESOs, controlling for patient age, gender, treatment site, distance travelled, and preoperative health. Conclusion: Emergency surgical officers at general hospitals performed a wide range of abdominal surgery with similar risks of in-hospital mortality, perioperative morbidity and surgical site infection versus similar procedures performed by physician surgeons. Cases performed by ESOs included appendectomy, bowel decompression, bowel resection, perforated peptic ulcer repair, colostomy creation, hemicolectomy, salpingectomy and oophorectomy, and abdominal trauma management with no additional detectable risk. Referral to surgical specialists remains essential in abdominal cases involving liver, spleen, gallbladder, pancreas, and complex vascular or oncological complications. Funding Statement: The funding source for this study was a grant provided by Dr. Mark Hardy, MD, Columbia University Department of Surgery, partially supported by the Il-song Education Foundation and Hallym University Global Medicine Program. Declaration of Interests: The authors have no financial conflicts of interest to disclose. Ethics Approval Statement: Ethical approval was granted by the Columbia University Medical Center Institutional Review Board with a designation of Exempt Research (IRB-AAAR9424) and by the Ethiopian Federal Ministry of Health (Ref. MT(1)/45/300).

Management of Abdominal Trauma with Liver Injuries among Patients in Riyadh, Saudi Arabia

Background: recently, there was a shift in the management plan for liver blunt trauma from operative to non-operative treatment, as there were advances in critical care and sensitivity of diagnostic tools for detection of liver injury such as CT scan. Objectives: To estimate the prevalence and correlates of non-operative management of liver injury among abdominal trauma patients admitted under surgical team care. Patients and Methods: this is a retrospective cohort study carried out in Riyadh, Saudi Arabia from May 2017 to June 2018. All patients admitted to general surgery departments with abdominal trauma and liver injuries were included. Variables were obtained through file review. Results: the study included 54 patients with liver trauma. Their age ranged from 7 to 60 years with mean age of 29.2±11.3. Male was the dominant gender; with male to female ratio were 8 to 1. Regarding mechanism of injury, all cases of fall down and 88.9% of road traffic accidents compared to none of penetrating injury were treated non-operatively, p=0.011. Concerning CT grading, all cases of grade I compared to 75% of grade IV and 70% of grade III were treated non-operatively, p=0.016. Majority of patients treated non-operatively (45/48; 93.8%) compared to one third of those treated operatively (2/6; 33.3%) were improved on discharge, pConclusion: the prevalence of non-operative management of liver injury in Riyadh hospitals is currently very high, ever for high-grade injuries. Most of them were improved on discharge compared to those managed operatively.