Panamerican Journal of Trauma, Critical Care & Emergency Surgery

Register      Login

VOLUME 7 , ISSUE 1 ( January-April, 2018 ) > List of Articles

ORIGINAL ARTICLE

Manejo No Operatorio Del Trauma Abdominal Penetrante; En Que Pacientes Realizarlo

Carlos A Ordóñez, Marisol Badiel, Mónica A Morales García, Jenny M Vidal, Laureano Quintero, Juan M Carrión, Paola A Calderón

Keywords : Exploratory laparotomy, Hemodynamically stable, Nonoperative management, Penetrating abdominal trauma, Unnecessary surgery

Citation Information : Ordóñez CA, Badiel M, García MA, Vidal JM, Quintero L, Carrión JM, Calderón PA. Manejo No Operatorio Del Trauma Abdominal Penetrante; En Que Pacientes Realizarlo. Panam J Trauma Crit Care Emerg Surg 2018; 7 (1):24-32.

DOI: 10.5005/jp-journals-10030-1200

License: CC BY-NC 4.0

Published Online: 01-04-2018

Copyright Statement:  Copyright © 2018; Jaypee Brothers Medical Publishers (P) Ltd.


Abstract

Background: The incidence of penetrating abdominal trauma (PAT) has increased in recent decades as a consequence of the violence, becoming a main reason for consultations in emergency services. Its evaluation and management are defiant and evolve over time. The objective is to ratify the safety of the nonoperative management (NOM) of PAT, describe the clinical results and characteristics of patients with PAT who were offered NOM in a first-level hospital. Study design: This is a prospective cohort study conducted during February and May 2016. It includes all patients with PAT admitted to first-level public hospital. A NOM protocol was established in hemodynamically stable patients; hemodynamic monitoring and physical examination were done every 4 hours, tomography according to case; This study was approved by institutional ethics committee. Statistical analysis: chi-square test or Wilcoxon according to variable, significance 0.05. Results: A total of 46 patients were registered, 91.30% (n = 42) were men, with mean age 25.6 ± 8.6 years; 50% gunshot and 50% stab wound (SW); exploratory laparotomy was done in 52.2% (n = 24), unnecessary laparotomy 2.2% (n = 1); about 47.82% (n = 22) were MNO; of these, 77.27% (n = 17) was for SW and 22.72% (n = 5) for gunshot. Mean systolic blood pressure 90 (90–91) mm Hg, hazard ratio 83 (73–88), relative risk 19 (18–20). The injury location: thoracoabdominal 50% (n = 11), 36.36% (n = 8) anterior abdomen, 13.64% (n = 3) posterior abdomen and flanks; 22.72% (n = 5) required abdominal tomography; 50% (n = 11) had accompanying injuries. Mean hospital stay was 2 (2–3) days. Mortality and complications at the first month posttrauma were 0% (n = 0). Conclusion: The NOM of PAT is safe if you make a strict selection and monitoring protocol. Patients with PAT and without hemodynamic compromise involvement were successfully submitted to NOM and without any complication at 30 days, independently of the injured abdominal region. The abdominal CT scan with contrast should not be routine. Avoiding unnecessary surgery decreases the morbidity and mortality and hospital costs as long as it is first-level hospital and has a trauma and emergency surgeon available.


PDF Share
  1. Uribe M, Carvajal C, Cavallieri S. Trauma: La primera hora. Santiago: Mediterráneo; 1995.
  2. Lenworth JR, Bennett JB, Kantor W. Management of the multisystem-injured patient. En: Clarke KT, Germaine W, Jacobs L, editors. Emergency medicine. 3rd ed. New York: Ravens; 1993. p. 93-104.
  3. Rainer TH, Swann J, Wewford R. Critical analysis of an accident and emergency ward. J Accident Emerg Med 1996 Sep;13(5):325-329.
  4. World Health Organization. Global burden of disease attributable to injuries, 2000 Estimates. In World Health Report. Geneva: IMS; 2001.
  5. World Health Organization; Krug, EG.; editors. World report on violence and health. Geneva: OMS; 2002.
  6. Tisminetzky G, Babio G.Control de danÞo. Rev Arg Med Cir Trauma 2002;3:144-153.
  7. Soto A, Torres E, Caballero J, Azabache-Puente W, Malca- Polo CE, Gonzáles-Portillo M, Rodríguez-Hurtado D, Vélez- Temoche J, Núñez-Huerta E, Moya-Charcape A, et al. Ensayo clínico Pragmático en trauma: el estudio Crash-2 en el Perú. Rev perú med exp salud publica 2008 Mar;25(1):138-143.
  8. Saìnchez LR, Ortiz GJ, Soto VR. Lesiones abdominales por trauma: expe riencia de dos anÞos en un hospital de tercer nivel. Cir Gen 2002 Jul-Sep;24(3):201-205.
  9. Sanchez R, Lama T, Carrillo E. Trauma abdominal. En Trauma. Sociedad Panamericana de Trauma. 2nd ed. Bogotaì: Distribuna Editorial; 2009., p. 307-315.
  10. Gonzaìlez A, Garciìa A. Trauma abdominal penetrante. En Trauma. Sociedad Panamericana de Trauma. 2nd ed. Bogotaì: Distribuna Editorial; 2009. p. 317-328.
  11. PatinÞo J.Trauma Abdominal. Guiìas para el manejo de urgencias de la Federacioìn Panamericana de Asociaciones de Facultades y Escuelas de Medicina 2003;22:246-254.
  12. Sánchez-Aguilar JM, Pinedo-Onofre JA, Guevara-Torres L, Sánchez-Aguilar JM. Trauma abdominal penetrante. Cirugía y Cirujanos 2006 Nov-Dec;74(6):431-442.
  13. Peìrez M, Garciìa A. Alcoholemia en muertes por trauma. Presentado en el VIII Congreso Panamericano de Trauma. Cartagena, XI 1994 (Nivel de evidencia III.3).
  14. Buitrago J, Calderoìn E, Lerma HD. Caracteriìsticas meìdicolegales de las muertes violentas en el aìrea de Pereira-Dosquebradas durante 1994. Rev Med Risaralda 1995;1:12 17.
  15. Gonzaìlez A. Reporte anual de Cirugiìa General. 1987-1991 (Nivel de evidencia III.2).
  16. Miller PR, Croce MA, Bee TK, Malhotra AK, Fabian TC. Associated injuries in blunt solid organ trauma: implications for missed injury in nonoperative management. J Trauma 2002 Aug;53(2):238-244.
  17. Shaftan GW. Indications of operation in abdominal trauma. Am J Surg 1960 May;99:657-664.
  18. Sartorelli KH, Frumiento C, Rogers FB, Osler TM. Nonoperative management of hepatic, splenic, and renal injuries in adults with multiple injuries. J Trauma 2000 Jul;49(1):56-62.
  19. García, A.; Niño, F. Manejo selectivo de las heridas abdominales por armas de fuego. Un estudio prospectivo. Colombia: Departamento de Cirugía. Universidad del Valle 2015.
  20. Como JJ, Bokhari F, Chiu WC, Duane TM, Holevar MR, Tandoh MA, Ivatury RR, Scalea TM. Practice management guidelines for selective nonoperative management of penetrating abdominal trauma. J Trauma 2010 Mar;68(3): 721-733.
  21. Angela Oyo-Ita A, Ugare UG, Ikpeme IA. Surgical versus non-surgical management of abdominal injury. Cochrane Database Syst Rev 2012 Nov;11:CD007383.
  22. Castillo-Moreno JR, Enríquez-Domínguez L, Herrera-Ramírez F, Rosales JD. Laparotomía no terapéutica en trauma penetrante abdominal y su relación con el estado de intoxicación por alcohol y drogas. Cir Gen 2011 Oct-Dec;33(4):232-235.
  23. Ricardo Ferrada D, Alberto García M, Edgar Cantillo S, Aristizábal G, Abella H. Guias de Practica Clinica Basadas en la Evidencia, Trauma de Abdomen, Asociacion Colombiana de Facultades de Medicina, Ascofame, en. Available from: www. medynet.com/usuarios/jraguilar/Trauma%20Abdomen.pdf.
  24. Herfatkar MR, Mobayen MR, Karimian M, Rahmanzade F, Gilani SB, Baghi I. Serial clinical examinations of 100 patients treated for anterior abdominal wall stab wounds: a cross sectional study. Trauma Mon 2015 Nov;20(4):e24844.
  25. Velmahos GC, Demetriades D, Toutouzas KG, Sarkisyan G, Chan LS, Ishak R, Alo K, Vassiliu P, Murray JA, Salim A, et al. Selective nonoperative management in 1,856 patients with abdominal gunshot wounds: should routine laparotomy still be the standard of care? Ann Surg 2001 Sep;234(3): 395-403.
  26. Anamaría Pacheco F. Trauma de abdomen. Rev Med Clin Condes 2011 Aug;22(5):623-630.
  27. Pinedo-Onofre JA, Guevara-Torres L, Sanchez-Aquilar JM. Trauma abdominal penetrante. Cir Ciruj 2006 Nov- Dec;74(6):431-442.
  28. Navsaria P, Nico A, Edu S, Gandhi R, Ball CG. Selective nonoperative management in 1106 patients with abdominal gunshot wounds: conclusions on safety, efficacy, and the role of selective CT imaging in a prospective single-center study. Ann Surg 2015 Apr;261(4):760-764.
  29. Velmahos GC, Demetriades D, Toutouzas KG, Sarkisyan G, Chan LS, Ishak R, Alo K, Vassiliu P, Murray JA, Salim A, et al. Selective nonoperative management in 1,856 patients with abdominal gunshot wounds: should routine laparotomy still be the standard of care? Ann Surg 2001 Sep;234(3):395-403.
  30. Biffl WL, Kaups KL, Pham TN, Rowell SE, Jurkovich GJ, Burlew CC, Elterman J, Moore EE. Validating the Western Trauma Association algorithm for managing patients with anterior abdominal stab wounds: a western trauma association multicenter trial. J Trauma 2011 Dec;71(6):1494-1502.
  31. Sanei B, Mahmoudieh M, Talebzadeh H, Shahmiri SS, Aghaei Z. Do patients with penetrating abdominal stab wounds require laparotomy? Arch Trauma Res 2013 Spring;2(1):21-25.
  32. Starling SV, Rodrigues Bde L, Martins MP, da Silva MS, Drumond DA. Non operative management of gunshot wounds on the right thoracoabdomen. Rev Col Bras Cir 2012 Jul-Aug;39(4):286-294.
  33. Salim A, Velmahos GC. When to operate on abdominal gunshot wounds. Scand J Surg 2002 Mar;91(1):62-66.
  34. MacGoey P, Navarro A, Beckingham IJ, Cameron IC, Brook AJ. Selective non-operative management of penetrating liver injuries at a UK tertiary referral centre. Ann R Coll Surg Engl 2014 Sep;96(6):423-426.
PDF Share
PDF Share

© Jaypee Brothers Medical Publishers (P) LTD.