Purpose: Penetrating abdominal trauma was traditionally managed by mandatory exploration, which led to high rates of non-therapeutic surgery and prolonged hospital stay. Diagnostic laparoscopy (DL) is a less-invasive alternative; however, it requires general anaesthesia and carries a potential risk of iatrogenic injuries. Contrast-enhanced computed tomography (CECT)-guided selective non-operative management (SNOM) may avoid surgery altogether, but there is apprehension of missed injury. Randomised trials comparing these two modalities are lacking. This study is aimed at comparing outcomes of these two management approaches.

Methods: Hemodynamically stable patients with penetrating trauma to anterior abdominal wall were randomised in 1:1 ratio to DL or CECT-based management. Primary outcome was length of hospital stay (LOS). Secondary outcomes were rate of non-therapeutic surgery, complications, and length of intensive care unit (ICU) stay.

Results: There were 52 patients in DL group and 54 patients in CECT group. Mean LOS was comparable (3 vs 3.5 days; p = 0.423). Rate of non-therapeutic surgery was significantly lower in CECT group (65.4 vs 17.4%, p = 0.0001). Rate of complications and length of ICU stay were similar. Selective non-operative management based on CECT findings was successful in 93.8% of patients; 2 patients had delayed surgery.

Conclusion: In patients with penetrating trauma to anterior abdominal wall, DL and CECT-based management led to comparable hospital stay. Significant reduction in non-therapeutic surgery could be achieved using a CECT-based approach.

Trial Registration: Clinical trials registry-India (CTRI/2019/04/018721, REF/2019/01/023400).

Download full-text PDF

Source
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC9387422PMC
http://dx.doi.org/10.1007/s00068-022-02089-5DOI Listing

Publication Analysis

Top Keywords

non-therapeutic surgery
16
patients penetrating
12
hospital stay
12
contrast-enhanced computed
8
computed tomography
8
penetrating abdominal
8
abdominal trauma
8
selective non-operative
8
non-operative management
8
penetrating trauma
8

Similar Publications

Purpose: Few studies have evaluated the health-related quality of life (HRQoL) of patients with diffuse low-grade glioma (LGG) during a clinical and radiological monitoring period. We report a cross sectional cohort study of HRQoL in patients with LGG and compare the results with normative population data. We then explore factors associated with HRQoL.

View Article and Find Full Text PDF

Influence of air pollution on the nonaccidental death before and after the outbreak of COVID-19.

BMC Public Health

November 2024

Department of Epidemiology, Key Laboratory of Public Health Safety and Emergency Prevention and Control Technology of Higher Education Institutions in Jiangsu Province, Center for Global Health, School of Public Health, Nanjing Medical University, 101 Longmian Ave. Nanjing, Nanjing, 211166, China.

Article Synopsis
  • During the COVID-19 pandemic, non-therapeutic interventions led to a decrease in air pollutants, but the effect of these changes on nonaccidental death rates had not been deeply studied.
  • In Yancheng City, China, researchers used a Generalized Additive Model (GAM) to analyze air quality and its impact on death rates from 2013 to 2022, finding significant declines in pollutants like PM, SO, and NO after COVID-19 began.
  • The study revealed that an increase in PM levels after COVID-19 correlated with a higher risk of nonaccidental deaths, particularly affecting men, while before the pandemic, multiple pollutants had an impact on cardiovascular-related deaths, with focus shifting mainly to PM after
View Article and Find Full Text PDF

Endoscopy-induced complication of barotrauma with concomitant benign pneumoperitoneum.

S Afr J Surg

October 2024

Department of Surgery, Thelle Mogoerane Regional Hospital, University of the Witwatersrand, South Africa.

Endoscopy is widely used for diagnostic and therapeutic purposes in modern clinical practice. Two of the less common complications are barotrauma and benign pneumoperitoneum. In isolation, these two complications have been successfully managed conservatively.

View Article and Find Full Text PDF

Thymic pathologies represent the most common lesions of the anterior mediastinum. They may be classified as malignant or benign. Current diagnostic pathways recommend an initial assessment with computed tomography (CT) imaging to delineate potentially malignant thymic lesions.

View Article and Find Full Text PDF
Article Synopsis
  • Eribulin is a microtubule dynamics inhibitor that shows potential for managing brain tumors, especially breast cancer brain metastases, due to its lower protein binding and resistance to P-glycoprotein extrusion.
  • A clinical study involved administering eribulin to cancer patients post-tumor removal, with samples analyzed to measure its concentrations in the brain and plasma.
  • Results indicated higher concentrations of eribulin in areas where the blood-brain barrier was disrupted, but overall levels in the brain were not enough to confirm consistent clinical effectiveness against brain tumors.
View Article and Find Full Text PDF

Want AI Summaries of new PubMed Abstracts delivered to your In-box?

Enter search terms and have AI summaries delivered each week - change queries or unsubscribe any time!