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Chirurgia 2007 August;20(4):199-202


language: English

High success with nonoperative treatment of blunt complex abdominal trauma. A case report

Tagliabue F. 1, Confalonieri G. 1, Romelli A. 1, Limonta M. E. 1, Spagnolo S. 1, Faccioli P. 2, Costa M. 1

1 Department of Surgery A. Manzoni Hospital, Lecco, Italy 2 Department of Radiology A. Manzoni Hospital, Lecco, Italy


Over the past two decades nonoperative management of blunt abdominal trauma has been demonstrated to be safe and highly successful in selected adults and children. Criteria for nonoperative treatment include hemodynamic stability, absence of associated intra abdominal injury requiring laparotomy on quality dual contrast CT scan, Intensive Care Unit monitoring and the ability to operate emergently in the event of a sudden change in clinical status. The authors present a case of blunt complex abdominal trauma in a woman victim of a high-speed motor vehicle accident, with a Glasgow Coma Scale of 7, blood pressure of 90/60 mmHg, tachicardic (100 beats/min) and with blood haemoglobin level of 6.5 g/dl. After resuscitative measures a total body CT scan showed a big haematoma of zone I and II of the neck with left dislocation of the trachea, and a haematoma of the upper mediastinum due to blunt trauma of the thyroid gland; in the abdomen a large amount of free intra-abdominal fluid, consistent with hemoperitoneum, caused by a grade IV injury of the liver involving the right hepatic lobe, and by a grade III injury of the spleen; major pelvic fractures with fractures of both femurs. In consideration of the young age of the patient of the hemodynamic stability rapidly responsive to resuscitative measures and of concomitant life-threatening conditions such as head injury, thoracic trauma and major pelvic fractures, the authors decided for nonoperative management of the abdominal injuries and transferred the patient to the Intensive Care Unit (ICU), for strictly monitoring.

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