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Selective Non-operative Management of Patients with Abdominal Trauma—Is CECT Scan Mandatory?

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Abstract

CECT scan is considered essential for selective non-operative management (SNOM) of patients with abdominal trauma. However, CECT has its own hazards and limitations. We evaluated the safety and efficacy of selective non-operative management of patients with abdominal trauma without the mandatory use of CECT scan in a prospective study. Patients with peritonitis and ongoing intra-abdominal bleed were excluded. Consenting FAST positive, hemodynamically stable patients with blunt and penetrating abdominal trauma between 18 and 60 years of age were included and admitted for SNOM and detailed ultrasonography of the abdomen (in all) with or without CECT abdomen (selectively). Eighty-four patients with abdominal trauma were admitted during the study period. Twenty-two patients did not satisfy the inclusion criteria and 18 required immediate laparotomy based on primary survey. Remaining 44 patients were admitted for SNOM: mean ± SD age of these patients was 27 ± 8.7 years; 40 (89 %) were males. Thirty-five patients (79.54 %) sustained blunt trauma (RTI = 16, Fall = 16, others = 3) while nine patients (20.45 %) sustained penetrating trauma. SNOM without CECT was successful in 36 (81.82 %) patients. Five (11.36 %) patients underwent delayed emergency laparotomy based on clinical and detailed USG evaluation. CECT was not done in these patients. Three patients underwent CECT for various reasons; however, they were managed with SNOM. Thus, SNOM without abdominal CECT was successful in 36 (81.82 %) patients. SNOM failed in five patients but abdominal USG was sufficient. SNOM can be practised safely in patients of abdominal trauma with limited use of CECT scan.

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Authors and Affiliations

  1. Department of Surgery, University College of Medical Sciences (UCMS) and Guru Teg Bahadur Hospital (GTBH), New Delhi, 110093, India

    Sunil Kumar & Puneet Prakash

  2. Department of Surgical Disciplines, All India Institute of Medical Sciences, New Delhi, 110029, India

    Mohit Kumar Joshi

  3. Department of Radiodiagnosis, University College of Medical Sciences (UCMS) and Guru Teg Bahadur Hospital (GTBH), New Delhi, 110093, India

    Vinita Rathi

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  1. Sunil Kumar
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  2. Puneet Prakash
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Correspondence to Mohit Kumar Joshi.

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Kumar, S., Prakash, P., Joshi, M.K. et al. Selective Non-operative Management of Patients with Abdominal Trauma—Is CECT Scan Mandatory?. Indian J Surg 79, 396–400 (2017). https://doi.org/10.1007/s12262-016-1494-x

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  • DOI: https://doi.org/10.1007/s12262-016-1494-x

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