Selective Nonoperative Management of Abdominal Injuries in Polytrauma Patients: a Protocol only for Experienced Trauma Centers.

Introduction: Nowadays we are facing a steep increase in non-operative management throughout the injured body areas, with a continuous increase in the injuries' grade.

Objective: To evaluate the safety and applicability of non-operative management in major trauma patients.

Methods: Prospective observational study, in a level I trauma center, during 30 months.

Inclusion Criteria: major trauma patients with abdominal visceral lesions.

Results: There were 207 major trauma patients whose average age was 35.8 ± 17.2 years, male being 69.6%. The most severe abdominal injuries were in the spleen (32.9%), the liver (19.2%) and the small bowel (11.6%). For the spleen lesions, the non-operative management was successful in 57.9% cases , with a failure rate of 11.6%. Non operative management was successful in 50% of liver injuries, its rate of success being independent of the hepatic injury grade.

Conclusions: Selective non operative management of abdominal visceral injuries is safe and effective in major trauma patients. Nevertheless, we should stress that this type of protocol should be applied only by highly trained surgeons, able to early convert this management to difficult surgical strategies.