Non-operative Management In Solid Organ Injuries After Blunt Abdominal Trauma-Splenic Injuries

Year 2021, , 105 - 110, 30.06.2021

Mehmet Aykut Yıldırım , Ahmet Tekin Mehmet Sinan İyisoy , Murat Çakır , Cengiz Kadıyoran , Tevfik Küçükkartallar , Celalettin Vatansev , Faruk Aksoy , Metin Belviranlı Adil Kartal

https://doi.org/10.15321/GenelTipDer.2021.294

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.

Keywords

Non-operative management, splenic injury, blunt trauma

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

Abstract

Amaç: Künt karın travmasına bağlı solid organ yaralanması olan hastalarda nonoperatif tedavi (NOT) uygulaması güncel yaklaşımdır.NOT uygulanan travmalı hastaların takibinde halen birliktelik yoktur. Çalışmamızda literatürde NOT uygulama aşamasında bazı aydınlatılmayan alanlara ışık tutmayı amaçladık.

Materyal-Metod: Çalışmamızda künt karın travmasına bağlı dalak yaralanması tespit edilen hastalar değerlendirildi. NOT başarılı olan hastalar ve NOT başarısız olup laparatomi yapılan hastalar tasnif edildi. Laparotomiye dönüş kriterlerimiz ise yeterli resusitasyona rağmen hemodinaminin instabil olması ve peritoneal irritasyon bulgularının varlığıydı.Yaralanma derecesine göre kendi içlerinde karşılaştırılarak analiz edildi.Gruplar karşılaştırılırken demografik bilgiler, travmanın oluş şekli,girişteki hemodinamik durum, BT’de yaralanmanın derecesi, yatış süresi boyunca kan ve kan ürünleri transfüzyonu gereksinimi, laparatomi gereksinimi, hastanede kalış süreleri, yoğun bakım ihtiyacı, ilk başvurudaki hemoglobin/hematokrit/lökosit sayısı değişimi ve oral beslenme zamanının tayini parametreleri kullanıldı.

Bulgular: NOT uygulanan 72 vaka retrospektif olarak değerlendirildi. 10 hastada NOT uygulanırken başarısızlıkla sonuçlandı ve laparatomi uygulandı.

Sonuç: Grade 3 ve üzeri yaralanmaların takibinde görüntüleme tetkikleri gerekebilir. NOT uygulanan hastalara hastaneye girişten itibaren yakın hemodinamik izlem, sık tekrarlayan fizik muayene ve etkin sıvı resusitasyonu yapılmalıdır. NOT uygulanan dalak travmalı hastalarda taburculuk sonrası erken dönemde yeniden kanama ve splenik abse gibi komplikasyonların olabileceği akılda tutulmalıdır.

Keywords

Non-operative management, splenic injury, blunt trauma

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