Background: Multisystem trauma in elderly patients with significant cardiac dysfunction presents a complex and high-risk management challenge. In hemodynamically stable individuals, the physiological stress imposed by general anesthesia and emergency laparotomy—including potential cardiovascular decompensation—may outweigh the anticipated benefits of operative intervention. Consequently, careful patient selection is essential. Contemporary evidence supports a selective non-operative management (NOM) approach for retroperitoneal and mesenteric hematomas in stable patients, particularly in the absence of radiological evidence of active bleeding. This strategy relies on close clinical monitoring, serial imaging when indicated, and prompt intervention should signs of deterioration arise. Case Presentation: We report the case of a 63-year-old male with a background of ischemic heart disease and dilated cardiomyopathy (ejection fraction 25%), conferring a moderate-to-high anesthetic risk, who sustained blunt abdominal and maxillofacial trauma following a motorbike collision with a wild animal. On presentation, he was hemodynamically stable but exhibited active bleeding into the oral cavity with impending airway compromise, necessitating an emergency tracheostomy. Contrast-enhanced imaging revealed a large left anterior pararenal (Zone II) retroperitoneal hematoma measuring approximately 8 cm, associated with moderate hemoperitoneum and subtle colonic mural thickening, in the absence of pneumoperitoneum or contrast extravasation. In view of his hemodynamic stability and significant comorbid status, a decision was made to pursue non-operative management, comprising close clinical observation with serial abdominal examinations and laboratory monitoring. The patient demonstrated a favourable clinical course and recovered without the need for surgical intervention. Conclusion: This case illustrates that in high-risk cardiac patients, careful adherence to hemodynamic parameters and imaging findings can permit safe non-operative management of significant blunt abdominal trauma while minimizing anesthetic risk.
Abeysinghe AHMGB*, Senananda SLDC, De Silva KKMH (Tue,) studied this question.