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OUTCOMES OF FAILURE OF SELECTIVE NONOPERATIVE MANAGEMENT OF PENETRATING ABDOMINAL TRAUMA [HREC/REF: 679/2013].

BACKGROUND
Selective nonoperative management (NOM) of penetrating abdominal trauma is routinely managed in our trauma center.


METHOD
All patients for the period 01 May 2015-15 June 2016 who presented with a penetrating abdominal injury were prospectively entered into an ethics approved database, Ethrapp, and retrospectively reviewed. The patients were categorised into 3 groups: immediate laparotomy, successful NOM and failed NOM. Outcomes included: postoperative complications, mortality and length of hospital stay.


RESULTS
A total of 485 patients with penetrating abdominal trauma were managed over the 13-month period. Of these, 219 (45%) were initially selected for NOM and the remaining 266 (55%) patients underwent immediate laparotomy. Twenty-six (26; 12%) failed abdominal observation. Increasing abdominal tenderness and radiological study Results were the primary factors used to determine the need for laparotomy in the NOM group. The median delay to laparotomy was 44.5 hours (27-68). Seven hollow viscus, 13 solid organ and 6 diaphragm injuries were found at laparotomy. There were 22 therapeutic, 2 negative and one non-therapeutic laparotomy. 90% of the immediate group underwent a therapeutic laparotomy. There was no mortality in the NOM group. Complications showed no significant difference.


CONCLUSION
The delayed diagnosis and treatment of failed NOM for penetrating abdominal trauma result in morbidity, mortality and hospital stay comparable with those who undergo immediate laparotomy.