Nonoperative management of solid organ injuries. Past, present, and future.

摘要: All patients with injuries to the solid organs of abdomen and who are hemodynamically stable should be considered candidates for nonoperative management after their have been staged by abdominal CT scanning, but because stage injury does not always predict which require laparotomy, these must remain under care experienced trauma surgeons can only recognize presence an associated hollow viscus in need repair also will readily available operate if approach fails. Until continued bleeding safely ruled out, a period close monitoring ICU-like setting seems warranted. Although delayed from liver extremely rare, rupture spleen hemorrhage into retroperitoneum injured kidney unusual, so splenic renal repeat imaging procedures before discharge. Others likely benefit second look at include subcapsular hematomas, recognized extravasation on initial scan, athletes anxious return contact sports. Experience major centers suggests that incidence missed intestinal is low adults children managed nonoperatively, diligent increasing pain, distention, vomiting, signs inflammation, may manifestations disruption. Patients vascular (grade V spleen, liver, or kidney) radiologic procedures, such as angioembolization stenting, some best served immediate laparotomy. Selected penetrating approach, further research this area needed widely embraced. As we year 2000, hepatic, splenic, continue role treatment patients. Currently, morbidity mortality rates acceptably low, still monitor results carefully they apply methods more liberally among