Nonoperative Management of Complex Thoraco-Abdominal Trauma: A Case Report

ABSTRACT Introduction: Thoraco-abdominal trauma resulting from a high-energy mechanism is characteristically seen with more than a single organ system injury, thereby resulting in complicated management issues with a high possibility of morbidity and mortality. Though surgical treatment is generally planned for multi-organ injury, nonoperative management can also be attempted. This approach, as evidenced by our case report, requires judicious patient selection, with an emphasis on hemodynamic stability and the potential for an optimal result.Case Presentation: A 66-year-old male suffered severe thoraco-abdominal trauma during a high-speed motorcycle collision and presented five hours post-injury. He was hemodynamically stable but complained of severe chest and abdominal pain. On initial CT, he presented with bilateral hemothorax, multiple rib fractures on the left, hepatic contusions of segments IV–V, splenic Grade I injury, non-visualization of the right kidney, and moderate intraperitoneal fluid. Laboratory findings revealed hepatocellular injury, characterized by highly elevated transaminases (ALT 1120 U/L, AST 542 U/L), and mild anemia (hemoglobin 11.9 g/dL). Progressive fall in hemoglobin to 10.8 g/dL on day two, accompanied by elevated pancreatic enzymes (amylase 225 U/L, lipase 160 U/L) and thrombocytopenia (platelets 120 × 10³/μL), suggested early pancreatic injury. Repeated imaging on day three confirmed uncinate process pancreatic edema with the resulting retroperitoneal fluid collection.Management and Outcome: The patient was successfully treated nonoperatively through vigorous monitoring protocols, including serial clinical exams, laboratory surveillance, and interval imaging. This constant monitoring, which enabled the timely intervention and adjustments, was instrumental in the patient's persistent clinical and biochemical recovery throughout his hospital course. There was no need for invasive procedures or blood transfusions, and the patient was discharged uneventfully with complete resolution of his injury.Conclusion: The case shows that nonoperative management in hemodynamically stable patients with complex thoraco-abdominal trauma involving multiple organ systems is feasible. Success occurs only when stringent patient selection criteria are adhered to, such as the absence of active bleeding, peritonitis, and other life-threatening injuries. Proper monitoring protocols and well-coordinated multidisciplinary care, involving emergency medicine, trauma surgery, and radiology services, are also critical. Serial re-evaluation remains necessary to identify patients who require conversion to operative management.