Limitations Of Non Operative Management Of Abdominal Trauma

Non operative management is widely used in abdominal trauma because it allows better survival and better organ salvage. Moreover, it avoids the complications of a laparotomy. Nowadays its indications increase, with the help of arterial embolization. This technique was initially developed for patients with severe retroperitoneal trauma, primarily kidney and pelvic traumas. Embolization is now performed for hepatic and, more recently, splenic trauma. But radio interventional techniques have specific complications, and the risk/benefits ratio of an embolization must be evaluated by a highly trained multidisciplinary team, including a trauma surgeon and an anesthetist. Non-operative management is far from a non-surgical attitude: at any moment the patient can have signs of hemorrhage, hollow viscus perforation, pancreatic trauma or abdominal compartment syndrom. The surgeon should be able to recognize and treat in time all those pathologies. This involves a true effort in surgical training in the area of visceral traumatology in France. We emphasize the necessity of a vigilant medical and surgical surveillance of the patient with an abdominal trauma when the non-operative option was initially selected. This vigilant monitoring is based of the availability of a surgical, anesthetic and radiological team 24 hours a day and seven days a week.