American Surgical Association
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Role of Selective Nonoperative Management of Penetrating Abdominal Solid Organ Injuries
Demetrios Demetriades, MD, PhD, Pantelis Hadjizacharia, MD*, Carlos Brown, MD*, Kenji Inaba, MD*, Peter Rhee, MD*, Ali Salim, MD*
Univ of Southern California, LA, CA

OBJECTIVE(S):
Selective non-operative management of liver, spleen or kidney injuries has been an acceptable practice in blunt but not penetrating trauma. The present study evaluated the role of non-operative management is selected penetrating injuries to these organs.
METHODS:
Prospective, protocol driven study of penetrating injuries to the liver, spleen or kidney . Hemodynamically stable patients who had no signs of peritonitis underwent CT scan evaluation and were observed with serial clinical examinations. Outcomes included nontherapeutic operations, complications, need and amount of blood transfusions, and ICU and hospital stay.
RESULTS:
There were 127 admissions with penetrating intraabdominal solid organ injuries (GSW 91, SW 36 - liver 95, kidney 35, and spleen 23) . 76 patients (60%) were hemodynamically unstable or had signs of peritonitis and underwent emergency laparotomies, 6 (7.9%) of which were nontherapeutic. 51 patients (40%) were selected for nonoperative management. Eighteen of these patients required a subsequent laparotomy at a mean of 7.15 hours after admission, with no complications. Overall, 33 patients (26%) were successfully managed without an operation. Eleven (17.2%) of the total of 64 patients with severe solid organ injuries (grades III -V) were successfully managed nonoperatively and with no complications. If a policy of routine operation had been followed, a total of 42 patients (33%) would have undergone an unnecessary operation. By following this selective nonoperative management protocol only 9 (7.1%) underwent an unnecessary operation.
CONCLUSIONS:
Selective nonoperative management for penetrating intraabdominal solid organ injuries is safe and reduces the number of unnecessary operations.


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