Delayed Laparotomies in Blunt Injuries of the Abdomen: Incidence Rates, Causes, Mortality Rates and Hospitalization Times in a Group of 139 Operated Patients. A Retrospective Study
P. Chmátal; P. Kupka; V. Vlasák; H. Pavlovičová *
Chirurgické oddělení, Ústřední vojenská nemocnice Praha
; Katedra aplikované matematiky, Přírodovědecká fakulta Univerzity Karlovy Praha
Rozhl. Chir., 2006, roč. 85, č. 2, s. 59-63.
Monothematic special - Original
Employment of visualizing methods and achievements of conservative treatment methods have a major influence on the management of blunt abdominal injuries. The aim of the study is to assess incidence rates of, possibly, delayed surgeries and complications.
Patients and Methods:
The authors conducted a retrospective analysis in a group of 139 operated patients. A common algorithm was followed on their admission. The following parameters were assessed in patients operated later than 24 hours following their admission (GROUP A): a cause of the delay, a mortality rate and duration of their intensive care unit (ICU) hospitalization. The parameters were compared to those of a corresponding patient group operated no later than 4 hours after their admission (GROUP B).
The GROUP A included 17 (12.23%) patients. The delay median was 4 days (1–48). The diagnostics failed in 9 (52.94%), the conservative care failed in 8 (47.06%) subjects. The mortality rate was 29.41%. The GROUP B had significantly higher survival rates (p-value 0.0445). There was no statistically significant difference in the parameters of the ICU hospitalization duration.
Diagnostic conclusions of visualizing methods, including CT scans, cannot be fully relied on in blunt abdominal injuries, mainly in cases of intestinal and diaphragmatic injuries. When a conservative treatment is indicated, the patient has to be closely monitored while sustaining an active surgical approach.
blunt abdominal injury – algorithm of the abdominal injuries management