Conservative management of penetrating abdominal injuries

ABSTRACT

Non-operative management of penetrating abdominal trauma is not widely practiced modality of management in third world countries. Some retrospective studies showed that major surgical intervention was needed during operation in considerable percentage of patients and routine exploration laparotomy led to unacceptable negative explorations. The aim of this prospective study was evaluation of non-operative management in selected group of patients presented with gunshot and stab abdominal injuries. The study included 192 admitted cases, classified into two groups group A, 135 cases presented with abdominal gunshot injuries and group B, 57 cases presented with abdominal stab injuries. Both groups had no clear indication for laparotomy on admission. All patients received resuscitative measures, with repeated physical examination by the same senior surgeon and ultrasonography to detect any developing indication for laparotomy. Conservative management was abandoned in 27 patients [conversion rate 14%] and they were explored. The remaining 165 cases got benefit from conservative treatment [86%] and had satisfactory outcome without missed injuries. Mortality in gunshot group, included; four deaths in non-operated group and one postoperative death in an explored patient. While in the stab wounds group, included; two deaths in the non-operative group and three postoperative deaths in the explored patients. This form of management has a role in properly selected cases of penetrating abdominal trauma guided by strict protocol, monitoring of patient in surgical intensive care and preparedness to undertake an operation immediately when required. Conversion rate in our study is 14% and expected to be less in the next few years if we continue application of the same protocol