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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: 01-01-2017

Copyright Statement:  Copyright © 2018; The Author(s).


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.

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