Favorable results following selective non-surgical management
of blunt injuries to both the liver and spleen have been reported
extensively by many authors. Diagnostic laparoscopy (DL) was done
in an attempt to assess more fully the nature of the organ disruption,
the rate of ongoing hemorrhage, to evaluate the associated occult
injuries and to assist in patient selection for either conservative
management or laparotomy.
A total of 27 patients with 30 solid organ injuries (SOIs) were
included in the above outlined protocol and underwent DL, which
was successfully performed in all Of them. No patient experienced
haemo dynamic instability or any other complication attributed either
to the laparoscopy or pneumo peritoneum. DL allowed for the
inspection of 27 injuries of the spleen and liver, and a suspected
renal injury, with failure to visualize two splenic injuries. An
associated occult hollow viscus injury was demonstrated at the same
time. Fifteen patients out of the 27 studied patients were managed
conservatively because of findings with minor injuries with
acceptable hemostasis on DL. Twelve patients required laparotomy
because of extensive parenchyma! disruption, ongoing hemorrhage
and associated occult bowel injuries.
All patients selected for conservative management were
successfully treated without any failure. No major early
complications or any late complications were reported.
We conclude that DL has a benefit in the diagnosis and
management of SOI following blunt trauma to the abdomen. |
