Nonoperative treatment of blunt abdominal trauma (CHU Gabriel-Toure)

Formerly, any abdominal contusion with hemoperitoneum was amenable to surgery. But for more than two decades, with the advent of ultrasound and the tomodensitometry, the non-operative option has been recommended more and more. The objectives of our study were to determine the frequency of the non-operative treatment (TNO) of the hemoperitoneum in closed abdominal traumatisms, to identify the etiology with the mechanisms of onset, to describe the clinical and paraclinical signs, and to determine the indications of the non-operative treatment. A retrospective, descriptive study was carried out from January 1999 to December 2008 in general surgery of the CHU Gabriel-Toure of Bamako (Mali). We included all patients, who were hemodynamically stable with the absence of intestinal lesion, admitted for closed trauma of abdomen (TFA) with hemoperitneum confirmed by clinical and paraclinical signs. The cases of abdominal contusion with hemodynamic instability or an associated intestinal lesion were excluded from the study. We collected 405 cases of TFA, including 270 cases associated with hemoperitoneum. The TNO related to the expectancy armed with a clinical and paraclinic monitoring repeated. The study included 73 patients, including 50 men (68.5%) and 23 women (31.5%) with a sex-ratio of 2.26. The average age was 20.53 years. Pupils were most at risk with 40 cases (54.8%). The TNO accounted for 18% of the TFA and 0.3% of hospitalizations during the study period (N = 23,887). Fifty-six patients (76.8%) were admitted before the first six hours after the traumatism. Conjunctival paleness and arterial hypotension were found, respectively, in 26 (36%) and 8 (11%) patients. We observed a hemodynamic stability in 65 patients (89%) on admission, and 8 cases (11%) of instability having responded to an initial resuscitation favorably. Highway accidents (AVP) (44 cases; 60.3%) and falls (14 cases; 19.2%) were the main causes. Hemoperitoneum was of low abundance in 36 cases (49.3%), of average abundance in 34 cases (46.6%), and of great abundance in 3 cases (4.1%). ASP was performed in all patients (100%) and did not find a pneumoperitoneum. On ultrasound, the spleen was found to be most injured in 21 cases (28.8%) against 10 cases (13.7%) for the liver and 3 cases (4.1%) for the kidney. Seven patients (9.6%) could benefit from the scanner, including three cases of splenic lesions grade II, two cases of hepatic lesions grade II, and one case of renal lesion grade II. Six patients (8.2%) were transfused. The suites were simple in 66 cases (90.4%), and therapeutic failure was observed in seven patients (9.6%) operated secondarily. Mortality was zero. The average hospital stay was 7.8 days. Conclusion Currently, the TNO can be recommended for any patient who is hemodynamically stable with the absence of an associated intestinal lesion. It makes it possible to limit the number of white laparotomies and the risks associated with the surgery.