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A Journal on Surgery

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Chirurgia 1999 December;12(6):395-404

language: Italian

Hemoperitoneum: when and why an operative management. A guidelines proposal

Della Beffa V., Fusca M., Fontana D., Abrate M.

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Background. The emergency laparotomy in the hemoperitoneum is a much debated topic and in the literature there aren't well established treatment methods about it. For this reason in every case of hemoperitoneum the authors suggest easy criteria of assessment.
Methods. A retrospective-comparative study has been carried out between two consecutive series of patients with hemoperitoneum. In the first series (1985-1993) all of 40 patients with positive Diagnostic Peritoneal Lavage or Ecotomography underwent explorative laparotomy. In the second series (1994-98) 54 patients showing hemoperitoneum at the Echotomography or at the CT-Scan were studied considering the following criteria: 1) seriousness of the shock, according to precise systolic pressure, haemoglobin and haematocrit values; 2) presence of hemodynamic stability changeableness; 3) presence of deep wound; 4) presence of serious abdominal associated injuries; 5) CT-Scan classification of hepatic-splenic lesions according to OIS-Scale4; 6) Presence of ectopic pregnancy with high levels of urinary HCG. Taking into account these criteria, it is possible to choice between aggressive or conservative management.
Results. In the first period, mortality was 20%. In the second period it was only 5.5% and 4 patients recovered without operation.
Conclusions. On the basis of these criteria, some laparotomies can be avoided (in our series: 7.5%) while other patients must immediately undergo surgery instead of waiting for a long time and running the risk of delayed operation in critical conditions. This means a reduction of costs for the hospital and a safe standard in the management of hemoperitoneum patients.

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