Long term outcomes of nonoperative treatment of blunt abdominal trauma

122 Pages·2001·4.8 MB·English

by  Gutierrez, Matthew Alan

YALE
UNIVERSITY
CUSHING/WHITNEY
MEDICAL LIBRARY
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Long Term Outcomes of Nonoperative Treatment of Blunt Abdominal Trauma
A Thesis Submitted to the
Yale University School of Medicine
in Partial Fulfillment of the Requirements for the
Degree of Doctor of Medicine
by
Matthew Alan Gutierrez
2001
Mil MEDICAL LIBRARY
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LONG TERM OUTCOMES OF NONOPERATIVE TREATMENT OF BLUNT
ABDOMINAL TRAUMA. Matthew A. Gutierrez and Peter B. Angood.
Department of Surgery, Washington University Medical Center, Washington
University, St. Louis, MO. (Sponsored by Manish Tandon, Department of Surgery,
Yale University School of Medicine).
The purpose of this study was to determine if nonoperative treatment of blunt
liver and splenic injuries has any long-term consequences that may be detrimental to
patients. A retrospective review was conducted of 112 adult trauma patients that
were treated nonoperatively for blunt abdominal trauma between 1991 and 1998.
The patient records were followed up to see if this patient population had an
increased occurrence of medical problems that could be related to nonoperative
management. Approximately one patient developed post transfusion hepatitis, two
patients developed delayed hemorrhage of their injuries but continued to be managed
nonoperatively, one patient failed nonoperative treatment and required splenectomy,
three patients developed sepsis, and one patient died during nonoperative
management from an asthma exacerbation. There was no incidence of small bowel
obstruction in the series. It appears from this data that long-term complications
related to nonoperative management are minimal, and it should continue to be the
treatment of choice in hemodynamically stable patients who sustain blunt abdominal
trauma.