Conservative management of intraabdominal injuries

Abstract

Management of paediatric abdominal trauma has evolved over the
last 4 decades. Current strategies for non-operative management
of most blunt solid-organ injuries developed from the observation
that most of these injuries would ‘heal themselves’ and that
operative intervention could interfere with this process. Organs
most commonly injured are the liver and spleen, followed by
kidney, pancreas and hollow viscera. In this article I concentrate
on the subset of patients injured by blunt mechanisms, unless,
under exceptional circumstances, management of penetrating
abdominal injury should be active and aggressive, with nonoperative
management being the exception. Although conservative
management is appropriate for the vast majority of patients who
have sustained blunt abdominal trauma, one must not compromise
the care of unstable patients by persevering with a conservative
approach in the case of life-threatening haemodynamic instability.
Such patients require urgent surgery. The challenge is to identify
these patients without delay.