Management of Antemortem Lacerations

Treatment Options

For hemodynamically stable patients with abdominal lacerations without active bleeding or perforation, non-operative management (NOM) is recommended to reduce morbidity and mortality, as suggested by the American Society of Anesthesiologists 1, 2
For patients with established ongoing intraperitoneal bleeding, emergent hemostatic angio-embolization should be considered among other therapeutic options, according to the American College of Surgeons 1, 3
For penetrating abdominal trauma with suspected peritoneal violation, exploratory laparoscopy is recommended after initial radiologic survey in patients without clinical signs of peritonitis, as recommended by the Eastern Association for the Surgery of Trauma 4

Surgical intervention is indicated for progressive hemothorax after closed thoracic drainage in cases of lung lacerations, as suggested by the Western Trauma Association 5
Peritoneal violation with hollow viscus perforation requires surgical intervention, as recommended by the American College of Surgeons 6
Extrahepatic biliary tree injuries (WSES class II-III) should undergo reconstruction with hepaticojejunostomy or choledochojejunostomy, according to the World Society of Emergency Surgery 7

Non-operative management has evolved to become standard of care for many abdominal trauma cases, applicable in more than 80% of abdominal trauma cases, as suggested by the American Association for the Surgery of Trauma 1, 8
Conservative management is appropriate for small ruptures of intrathoracic trachea and bronchi, as recommended by the Society of Critical Care Medicine 9
Most lung lacerations can be managed with closed thoracic drainage, according to the American Thoracic Society 5

Delayed surgical intervention for antemortem hollow viscus perforation significantly increases mortality (fourfold increase when delay exceeds 24 hours), as reported by the American College of Surgeons 6
Non-therapeutic laparotomy increases hospital length of stay and carries significant risk of both immediate and long-term complications in otherwise young and healthy patients, as suggested by the Eastern Association for the Surgery of Trauma 4