Multiple abdominal trauma: Therapeutical options

OBJECTIVE: To revise a series of multiple abdominal trauma in order to evaluate the type of diagnosis process and therapy undertaken, the complication and patient survival rates. PATIENTS: Three hundred ten patients of whom 294 (94.8%) with a single abdominal organ injury associated or not with trauma of extra-abdominal organs (thorax, mediastinum, brain, bone) and 16 patients with a multiple abdominal injury (2 or more organs) associated or not with trauma of extra-abdominal organs. Age, gender, vital parameters, injury dynamics, number of organs, site of injury, Injury Severity Score (ISS), Abdominal Trauma Index (ATI) and Glasgow Coma Scale (GCS) have been recorded at admission. RESULTS: Multiple abdominal trauma represent 5% of all abdominal trauma. All trauma were closed ones: 14 street accident and 2 precipitations. A non operative management was undertaken in 6 patients, successfully completed in 2, while 4 patients required a surgical intervention to control bleeding within 12 hours of observation. Ten patients underwent immediate operation for unstable vital signs. The mean number of abdominal organs damaged was 2.8/patient. The mortality rate was 43.7% (7/16). All patients died during surgery. By comparing dead and surviving patient, initial haemodynamics and severity of ISS, GCS, and ATI scores were significant negative prognostic factors. The median length of hospitalisation of survivors was 12 days. CONCLUSIONS: Non operative management of multiple abdominal injury seems to be feasible in a small percentage and possibly only in selected cases.