Definitive Care of Abdominal Solid Organ Injuries

Non-operative management (NOM) for solid organ injuries has long become the standard of care and it continues to have high success rates in the appropriate patient population, both in blunt and penetrating trauma. In selected and well-developed trauma centers, NOM can even be pursued in borderline patients or transient responders without other indications for laparotomy. At the Trauma Center of the Ospedale Maggiore in Bologna (Italy), in the last 5 years the success rate of NOM was 75% for splenic injuries, 90.9% for hepatic injuries, 88.6% for pancreatic and 89.9% for kidney injuries, out of all traumas observed. The development of NOM has meant that we now perform surgical interventions only in unstable patients with serious bleeding lesions, which almost always require either removal of the organ or a damage control procedure. Other surgical options for the definitive treatment of such injuries are to be reserved for either complications of NOM, after damage control surgery (DCS) [4] or—as in the case of kidney and pancreatic trauma—when there is a rupture of the main duct or urine leakage.