POCUS in the Assessment and Monitoring of Abdominal Trauma During Nonoperative Management

The management of abdominal injuries is currently shifting from a strategy of mandatory exploration to the era of selective non-operative management (NOM). At present, NOM is the standard treatment for patients with abdominal trauma who are hemodynamically stable, with a success rate of approximately 80% to 90%. NOM can reduce the rate of non-therapeutic abdominal explorations and has been defined as the safest option in experienced centers equipped with readily available surgeons, operating rooms, intensive care units, and other support resources. However, this approach is not free of complications, which may vary according to the organ involved and the severity of the injury [1].This chapter aims to discuss clinical monitoring through the use of imaging studies, with emphasis on ultrasonography (US), in order to monitor potential complications and identify them at an early stage. In the introduction, we review the role of bedside ultrasonography, which is important for revealing the main complications arising from trauma to organs such as the liver, spleen, kidneys, and intestinal loops.In the development of this section, we detail that the ultrasonographic examination should be directed toward the detection of the main complications and toward follow-up of the regression of free fluid in the abdomen. We suggest strategies such as: if there is persistence or an increase in free fluid without associated hemodynamic instability, fluid sampling by percutaneous aspiration is recommended for laboratory analysis, including bilirubin, urea, creatinine, or amylase levels, in order to detect possible cases of bile peritonitis, as well as to investigate urinary or pancreatic fistulas.Finally, as a conclusion of the additional information presented, Doppler evaluation of the kidneys can be used to investigate thrombosis and pseudoaneurysms, whether in the spleen or the liver. This multidimensional approach using ultrasonography enhances patient management, allowing for more precise and effective clinical intervention.