Effect Of Prothrombin Complex Concentrate In Non-Operative Management For Treatment Of Severe Traumatic Intra-Peritoneal Abdominal Hematoma

Abstract

Background: Non-operative management (NOM) is increasingly used in selected severe abdominal trauma cases, with success rates of 80%–90%. The role of imaging as X ray and focused Assessment with Sonography for Trauma (FAST) serves as the initial bedside screening modality. CT is essential for selecting appropriate candidates, assessing injury severity, detecting active bleeding, and monitoring for complications during NOM. Adjuncts such as prothrombin complex concentrate may further support successful conservative treatment

Objective: This study aimed to evaluate the effect of Prothrombin Complex Concentrates (PCCs) on limiting the expansion of intraperitoneal hemorrhage after severe abdominal trauma, stabilizing hemoglobin levels, reducing intra-abdominal pressure, and improving tissue perfusion and coagulation profiles in ICU patients. Imaging, particularly contrast-enhanced CT, was essential for quantifying hemorrhage extent, monitoring hematoma progression, and assessing the therapeutic response to PCCs.

Methods: This prospective, double-blinded, randomized controlled study enrolled 80 patients with severe traumatic massive hemoperitoneum. Patients were randomly allocated to either group A(n=40), received our standard protocol of resuscitation or group B (n=40) received our standard protocol of resuscitation with administration of PCC. Size of intra-peritoneal hematoma, hemoglobin level, intra-abdominal pressure, daily urine output, arterial blood gases and coagulation profile were monitored daily. Also, number of patients discharged at the end of studied period was monitored.

Results: Patients in Group B exhibited a significantly decrease in the size of intra-peritoneal hematoma, exhibited stabilization in hemoglobin level, decreasing in the intra-abdominal pressure, restored normal tissue perfusion and coagulation profile. And higher rate of discharge at the end of the studied period.

Conclusion: this study clarifies the effect of PCC in controlling intra-peritoneal hematoma following abdominal trauma, stabilizing hemoglobin level, decreasing intra-abdominal pressure, restoring normal tissue perfusion and coagulation profile between patients with severe traumatic intra-peritoneal hematoma. And also increase rate of discharge from ICU between those patients. Imaging, primarily contrast-enhanced CT, played a crucial role in objectively assessing hematoma size, monitoring interval changes, and evaluating the therapeutic response to PCCs, thereby guiding clinical decision-making throughout patient management.