Regardless the degree of hepatic or splenic lesions, the authors treated traumatized patients with NOM or embolization according to their hemodynamic response. In 2017 Ruscelli et al presented the experience of the Cesena Trauma Center in which 732 patients were treated with NOM for blunt hepatic and splenic injuries reporting statistically significant positive results. It started with isolated pediatric splenic lesions but actually it is considered the gold standard treatment for trauma patients with specific parameters. The most important change in trauma patient's care over the last decades is represented by the switch to selective non-operative management (NOM). In 2013 1 study showed that the liver was the mostly affected organ and younger people were more vulnerable to hepatic and pancreatic injury. Hepatic injury takes the third place in abdominal injury and 80% to 90% of hepatic injuries are blunt ones. Liver is the solid organ with highest injury rate in abdominal injuries, and approximately 15% to 20% of these refer to hepatic trauma. Spleen represent the most commonly damaged organ during abdominal blunt trauma and is affected in about 33% of patients with traumatic abdominal injuries. Trauma is the major cause of mortality in population under 40 years and abdominal trauma is the third common trauma with a high rate of morbidity and mortality. Non-operative management for blunt hepatic and splenic lesions in stable or stabilizable patients seems to be the choice of treatment regardless of the grade of lesions according to the AAST Organ Injury Scale. All these patients received splenectomy: in 1 case to treat pseudoaneurysm, (AAST, American Association for the Surgery of Trauma, grade of injury II), in 2 cases because of re-bleeding (AAST grade of injury IV) and in the remaining case was necessary to stop monitoring spleen because the patient should undergo to orthopedic procedure to treat pelvis fracture (AAST grade of injury II). NOM failure occurred in 4 patients (5.3%) treated for spleen injuries. NOM was successful in 100% of cases of liver trauma patients and was successful in 94.7% of splenic trauma patients (72/76). The NOM overall outcome resulted in success in 107 patients (96.4%). Contrast pooling was found in 61 patients (54.95%). Each patient underwent CT scan at his admission. Management of patients was performed according to specific institutional pathway, and only patients from category A and B were treated conservatively regardless of the injury grade of lesions.įrom October 2015 to December 2017, a total amount of 111 trauma patients were treated with NOM. Patients were divided into 3 main groups according to their hemodynamic response to a fluid administration: stable (group A), transient responder (group B) and unstable (group C). We conducted a retrospective study applied on a patient's cohort, admitted in “Azienda Ospedaliero-Universitaria Ospedali Riuniti of Ancona” and in the Digestive and Emergency Surgery Department of the Santa Maria of Terni hospital between September 2015 and December 2017, all affected by blunt abdominal trauma, involving liver, spleen or both of them managed conservatively. This retrospective study shows the results of a 2 years application of a clinical pathway concerning the indications to NOM based on the patient's hemodynamic answer instead of on the injury grade of the lesions. The work cannot be changed in any way or used commercially without permission from the journal.
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This is an open access article distributed under the terms of the Creative Commons Attribution-Non Commercial-No Derivatives License 4.0 (CCBY-NC-ND), where it is permissible to download and share the work provided it is properly cited. The authors have no funding and conflicts of interests to disclose. Maria Hospital, Department of Digestive Surgery, Viale Tristano di Joannuccio, 05100 Terni, Italy (e-mail: ).Ībbreviations: AAST = American Association for the Surgery of Trauma, APACHE II = Acute Physiologic Assessment and Chronic Health Evaluation, ATLS = Advanced Trauma Life Support, CEUS = Contrast Enhanced Ultrasound, CT = computed tomography, NOM = non-operative management, OM = operative management. Maria Hospital, Viale Tristano di Joannuccio, TerniĮDepartment of Surgical Sciences, Sapienza University of Rome, Piazzale Aldo Moro 5, Rome, Italy. Maria Hospital, Viale Tristano di Joannuccio, TerniĬDepartment of Surgical Sciences, University of Perugia, Piazza dell’Università 1, PerugiaĭDepartment of Emergency, St. AEmergency Surgery Unit, Torrette Hospital, Polytechnic University of Marche, Via Conca 71, Torrette, AnconaīDepartment of Digestive Surgery, St.
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