Abdominal Trauma in the Elderly

The expansion of the elderly population led to an increased number of older adults presenting to emergency departments following trauma; the outcome of injuries in geriatric patients is worsened by a weaker mechanism of compensation, ongoing chronic medical conditions, and increased risk for complications due to a greater number of comorbidities and physiological changes. Decreased sensitivity to catecholamines and impaired compensatory tachycardia, anticoagulants, antiplatelet agents, beta-blockers, and other cardioactive/vasoactive medications may interfere with physiological responses and worsen the effects of hypovolemia. In abdominal trauma, reduced pain sensation and increased weakness of the abdominal wall, may make the abdominal examination more difficult and less reliable in the elderly. CT scan with intravenous contrast should be obtained in stable patients when an intraabdominal injury is suspected; contrast-induced nephropathy in elderly trauma patients is rare regardless of history of diabetes mellitus, age, creatinine, and high ISS. Older populations have major advantages from laparoscopic techniques if operational intervention is required. Indications and techniques for a laparoscopic approach in geriatric abdominal trauma does not differ significantly from their younger counterparts, but closer attention must be paid to their physiologic response and tolerance to general anesthesia and abdominal insufflation. In hemodynamically stable patients, laparoscopy represents a reliable diagnostic tool in blunt and penetrating trauma of the abdomen when performed by surgeons with appropriate skills. This results in a lower rate of nontherapeutic laparotomy as well as a shorter hospital stay, better respiratory management, and less postoperative pain when compared to the open approach. The minimal invasive technique may be indicated in the treatment of abdominal injuries, including primary repair of diaphragmatic, stomach, small and large bowel perforation, or in a delayed approach of complications related to hepatic trauma such biloma, abscess, or necrosis. Anticoagulation represents one more challenge when dealing with traumatic abdominal hemorrhage in the elderly; it is important to reduce the risk of bleeding in anticoagulated patients through reversal of the specific agent before the surgical intervention.