We have very good success rate in the

management of high grade renal injuries conservatively and the same is recorded in other centers [11, 21]. All extraperitoneal urinary bladder injuries were treated with CHIR-99021 mw transurethral catheter, including 4 patients with small intraperitoneal leaks. Blood transfusion requirement, morbidity, mortality and incidence of non-therapeutic laparotomy were significantly reduced with NOM. The successful management depends on repeated clinical assessment preferably by the same clinical team in HDU/ICU, hemodynamic stability, serial determination of hemoglobin, haematocrit, WBC and follow up ultrasound/CT scan, if indicated. However, routine repeate CT scan is not essential in clinically improving patients. Thumping of chest for physiotherapy is strictly forbidden in splenic and liver injuries. Conscious

patients not having spine, lower limb or pelvic fractures were mobilized within 48 hours. Initially hospital authorities and even our surgical colleagues were critical about NOM, but Selleck STI571 following successful results, NOM has now been accepted as a standard method of managing hemodynamically stable blunt abdominal trauma patients in most of the Trauma Centres including ours with a success rate of above 80% [4]. Heyn etal [12] suggested that in patients with multiple injuries abdominal ultra sound and CT have complementary value. Anatomical CT grading is an ineffective exclusion criterion for NOM or embolisation for splenic or hepatic trauma [15]. Earlier NOM was not preferred in polytraumatised patients but recently several reports of successful results in polytrauma with strict monitoring irrespective of age or other concomitant injuries have been reported [7, 22] and the same is reproduced in our study. Higher amount of blood transfusions triclocarban were given to maintain hemodynamic stability in patients with associated long bone, pelvic fractures, retroperitoneal hematomas and hemothorax etc. Isolated liver, spleen

or kidney injuries did not receive more than 3-4 pints of blood. In our analysis we did not find any significant differences between the operated and NOM group in relation to the age, co- morbidities and mechanism of injury. But the operated group presented with poor hemodynamic stability thus necessitating increased blood transfusion and higher rate of intubation in the Emergency Department as compared to the NOM group. As we look ahead the NOM will play major role in management of patients with blunt abdominal trauma. Conclusion NOM for blunt abdominal trauma was found to be highly successful and safe in our analysis. Management by NOM depends on clinical and hemodynamic stability of the patient, after definitive indications for laparotomy are excluded.