[Difficulties and errors in diagnosis and treatment of closed trauma to the abdominal organs]

A critical analysis of the difficulties and errors in the diagnosis and treatment of closed injuries to the abdominal organs during a period of 30 years is given. In the first period (1960-72) diagnostic laparotomy was applied widely in all questionable cases, which in 32 out of 252 (12.7%) patients failed to reveal injuries to the viscera, but aggravated the general condition and promoted a fatal outcome in some patients. Because of diagnostic doubts, 38 (15%) patients were kept under observation at the clinic for 6 to 48 hours; in 29 of them the operation was delayed, nine patients did not undergo surgery and injury to the abdominal organs was recognized only on postmortem examination. Total mortality was 32.1% (17.5% in isolated injury and 62.9% in concomitant injuries). During the second period (1973-89) 349 patients with similar injuries were under observation. With the wide use of laparocentesis and, less frequently, laparoscopy in diagnostic difficulties, the number of explorative laparotomies reduced to 2.8%, the time for establishing the diagnosis was shortened to 30-60 minutes, an authentic diagnosis was made in 96% of patients, and mortality decreased by 9% due to timely operation (it was 8.5% in isolated and 44.8% in concomitant injuries). The author points out that the results of laparocentesis and laparoscopy may be pseudonegative in some cases, which may lead to serious diagnostic and tactical errors. Similar errors were made in 30 (5%) patients during the operation itself because the main rules of examination of the abdominal cavity were not observed.