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

Overview

Introduction:
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).

Results:
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.

Conclusion:
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.

Key words:
blunt abdominal injury – algorithm of the abdominal injuries management