Non-operative management of blunt abdominal trauma in a tertiary sub-Saharan surgical department: a retrospective cross-sectional analysis of 19 cases

Background: Blunt abdominal trauma (BAT) is a leading cause of death and disability, particularly in low- and middle-income countries (LMICs). Non-operative management (NOM) has become the standard of care for hemodynamically stable patients without peritonitis. NOM remains difficult in cases of polytrauma. The rationale for this research stems from the fact that, despite global advances in trauma care, LMICs often face unique challenges such as limited access to imaging, delayed patient presentation, and variability in clinical decision-making. Methods: This retrospective cross-sectional study analyzed 19 out of 126 patients with BAT between 1 January 2016 and 31 December 2022. The study included adult patients who sustained BAT. Data on demographics, cause of injury, time of presentation, clinical signs, associated injuries, and mortality were collected. Results: We had a predominantly male cohort (84.2%), with a sex ratio of 5.3, and a mean age of 23.9 years. The most affected age group was 15–30 years (47.4%). Emergency medical transport was used in 42.1% of cases and 68.4% of patients received hospital management within 2 hours after injury. The leading causes of trauma were road traffic accidents (52.6%), followed by workplace accidents (26.3%). Patients selected for NOM were hemodynamically stable or transient hemodynamic responders at the time of treatment. Abdominal tenderness was present in 63.2% of cases, and one patient exhibited hematuria. Abdominal CT scans, conducted in 78.9% of patients, identified organ injuries in 86.7%, most commonly liver trauma (73.7%), followed by splenic injuries (15.8%). Over half of the patients (57.9%) had associated injuries, with thoracic trauma being the most frequent (31.6%). Most patients (68.4%) had a hospital stay of 10 days or less. The overall mortality rate was 21.1% (4 deaths). Deaths were attributed to both primary abdominal injuries and accompanying complications, particularly thoracic, hepatic, and splenic trauma. Conclusions: NOM of BAT can only be effective in LMIC if adequate resources are mobilized. LMIC with limited resources must invest considerably in pre-hospital care, multidisciplinary approach, and intra-hospital management to guarantee a safe use of such procedures for patients.