Conservative management of intra-abdominal injuries

Abstract

Conservative management of intra-abdominal injuries comprises the vast majority of the management of injured paediatric patients, particularly where the mechanism is blunt force trauma. Organs most commonly injured are the liver and spleen, followed by kidney, pancreas and hollow viscera. It is the subset of patients injured by blunt mechanisms that I will concentrate on, as unless under exceptional circumstances, management of penetrating abdominal injury should be active and aggressive, with non-operative management being the exception. It must also be stated at the outset that although conservative management is appropriate for the vast majority of patients that have sustained blunt abdominal trauma, one must not compromise the care of unstable patients by indefinitely persevering with a conservative approach in the presence of life threatening haemodynamic instability. These patients require urgent surgery.


Whilst blunt trauma forms the vast majority of paediatric injury worldwide, and although poorly documented in recent years, South Africa sees a particularly high volume of such cases, primarily due to a high incidence of both motor vehicle and pedestrian vehicle accidents. Improving road safety needs to be given urgent priority in the future to reduce this incidence.

Irrespective of the presence and/or standard of pre-hospital emergency medical services, in-hospital treatment hinges around a thorough examination in the resuscitation room, appropriate medical intervention, particularly fluid therapy, further directed haematological and radiological investigation, and thereafter appropriate ongoing care, which with appropriate monitoring will be conservative in the vast majority of cases.