NonOperative Management of Blunt Solid Abdominal Organ Injury in Calabar, Nigeria

Asuquo Maurice, Bassey Okon, Etiuma Anietimfon, Ngim Ogbu, Ugare Gabriel, Anthonia Ikpeme

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DOI: 10.4236/ijcm.2010.11006                

Abstract

Background: Over the past several years, nonoperative management has been increasingly recommended for the care of selected blunt abdominal trauma patients with solid organ injuries. Objective: To evaluate the pattern and outcome of blunt abdominal trauma using haemodynamic stability and ultrasonography in the selection of patients for nonoperative management in a facility without computed tomogram. Methods: Patients admitted with blunt abdominal trauma between February 2005 and January 2010 were prospectively studied. Haemodynamic stability and sonography formed the basis for selecting patients for nonoperative management. Results: In total, 58 patients suffered blunt abdominal trauma and 19(33%) patients were successfully managed nonoperatively suffered blunt solid abdominal organ injuries. Road traffic accidents inflicted 17(89%) patients while 2(11%) patients sustained sports injury (football). The spleen was the commonest solid organ injured 12(60%), while the liver and kidney were injured in 6(30%) and 2(10%) respectively. Associated injuries were fractured left femur recorded in 3(16%) patients and fractured rib in a patient (5%). Conclusion: Nonoperative treatment is a safe and effective method in the management of haemodynamically stable patient with blunt solid abdominal organ injury. This translated to a reduction in hospital stay, absence of the risk of blood transfusion as well as attendant morbidity and mortality associated with laparotomy. Establishment of trauma system, provision of diagnostic and monitoring facilities, good roads, and education on road safety is recommended for improved outcome.

Keywords

Blunt Abdominal Trauma, Solid Organ Injury, NonOperative Management

Conflicts of Interest

The authors declare no conflicts of interest.

References

[1]	D. E. Gibson, C. M. Canfield and P. D. Levy, “Selective NonOperative Management of Blunt Abdominal Trauma,” Journal of Emergency Medicine, Vol. 31, No. 2, 2006, pp. 215221.
[2]	S. P. Stawicki, “Trends in Nonoperative Management of Traumatic Injuries,” OPUS 12 Scientist, Vol. 1, No. 1, 2007, pp. 1935.
[3]	P. R. Miller, M. A. Croce, T. K. Bee, A. K. Malhotra and T. C. Falran, “Associated Injuries in Blunt Solid Organ Trauma: Implication for Missed Injury in NonOperative Management,” Journal of Trauma, Vol. 53, No. 2, 2002, pp. 238242.
[4]	K. L. McKenny, “Ultrasound of Blunt Trauma,” Radiologic Clinics of North America, Vol. 37, No. 5, 1999, pp. 879893.
[5]	M. A. Brown, C. B. Sirlin, D. B. Hoyt and G. Casola, “Screening Ultrasound in Blunt Abdominal Trauma,” Journal of Intensive Care Medicine, Vol. 18, No. 5, 2003, pp. 253260.
[6]	Y. G. Goan, M. S. Huang and L. Jin, “Non Operative Management of Extensive Hepatic and Splenic Injuries with Significant Haemoperitoneum in Adults,” Trauma, Vol. 45, No. 2, 1998, pp. 360365.
[7]	J. Udeani and S. R. Steinberg, “Abdominal Trauma: Blunt,” E Medicine Journal, 2006. http://med.javeriana. edu.co/pediatria/revis/eMedicineudeani.htm
[8]	G. Norman, B. Tingstedt, M. Ekelund and R. Andersson, “Nonoperative Management of Blunt Splenic Trauma: Also Feasible and Safe in Centres with Low Trauma Incidence and in the Presence of Established Risk Factors,” European Journal of Trauma and Emergency Surgery, Vol. 35, No. 2, 2009, pp. 102107.
[9]	A. Y. Yaghoubi Notash, H. A. Ahmadi Amoh, A. Nikandish, A. Yazdankhah Keran, F. Jahangiri and P. Khashayer, “NonOperative Management of Blunt Splenic Trauma,” Emergency Medicine Journal, Vol. 25, No. 4, 2008, pp. 210212.
[10]	G. C. Velmahos, K. Toutouzas, R. Radin, L. Chan, P. Rhee, A. Tillou and D. Demetriades, “High Success with NonOperative Management of Blunt Hepatic Trauma,” Archives of Surgery, Vol. 138, No. 5, 2003, pp. 475481.
[11]	W. C. Chiu, B. M. Cushing, A. Rodriguez, S. H. Ho, S. E. Mirvis, K. Shanmuga Nathan, M. Stein, “Abdominal Injuries without Haemoperitoneum a Potential Limitation of Focused Abdominal Sonography for Trauma (FAST),” Journal of Trauma, Vol. 42, No. 4, 1997, pp. 617623.
[12]	M. E. Asuquo, V. Nwagbara, A. Inyang and G. Ugare, “Blunt Abdominal Trauma in Calabar,” Nigeria Journal of Surgical Science, Vol. 16, No. 3, 2006, pp. 1215.
[13]	M. N. Okobia and U. Osime, “Abdominal Trauma in Benin, Southern Nigeria,” Nigeria Journal of Surgery, Vol. 5, No. 2, 1998, pp. 4954.
[14]	D. Dogo, T. Yawe, A. W. Hassan and B. Tahir, “Pattern of Abdominal Trauma in NorthEastern Nigeria,” Nigeria Journal of Surgical Research, Vol. 2, No. 2, 2000, pp. 4851.
[15]	A. S. AlMulhim and H. A. H. Mohammed, “Non Operative Management of Blunt Hepatic Injury in Multiple Injured Adult Patients,” Journal of Royal College of Surgeons in Ireland, Vol. 1, No. 2, 2003, pp. 8185.
[16]	S. Gopalswamy, R. Mohanraj, P. Viswanathan and V. Biskaran, “Nonoperative Management of Solid Organ Injuries due to Blunt Abdominal Trauma (NOMAT). SevenYear Experience in a Teaching District General Hospital. A Prospective Study,” Internet Journal of Surgery, Vol. 15, No. 2, 2008.
[17]	H. A. Bismar, M. K. Alam, M. H. AlKeely, S. M. Al Salamah and A. A. Mohammed, “Outcome of Nonoperative Management of Blunt Liver Trauma,” Saudi Medical Journal, Vol. 25, No. 3, 2004, pp. 294298.
[18]	A. B. Peitzman, B. G. Harbrecht, L. Rivera and B. Heil, “Failure of Observation of Blunt Splenic Injury in Adults: Variability in Practice and Adverse Consequences,” Journal of the American College of Surgeons, Vol. 201, No. 2, 2005, pp. 179187.
[19]	A. K. Malhotra, T. C. Fabian, M. A. Croce, T. J. Gavin, K. A. Kudsk, G. Minard and F. E. Pritchard, “Blunt Hepatic Injury: Paradigm Shift from Operative to Nonoperative Management in the 1990s,” Annals of Surgery, Vol. 231, No. 6, 2000, pp. 804813.
[20]	T. J. Schroeppel and M. A. Croce, “Diagnosis and Management of Blunt Abdominal Solid Organ Injury,” Current Opinion in Critical Care, Vol. 13, No. 4, 2007, pp. 399404.
[21]	W. Boggs, “Early Mobilization Safe for Patients with Blunt Solid Organ Injuries,” Archives of Surgery, Vol. 143, No. 10, 2008, pp. 972976.