Nonoperative management of traumatic liver injuries

Abstract

BACKGROUND: Nonoperative management (TNO) of traumatic liver injury is the choice in hemodinamically stable patients without other abdominal injuries requiring celiotomy, apart from liver injury grading and amount of free peritoneal bood. CT-scan and angiographic embolization availability increase TNO feasibility.

AIMS: To investigate feasibility of TNO in 16-months period consecutive liver injuries.

MATERIALS AND METHODS: All data of severe trauma patients admitted to our facility during the study period were recorded. Clinical decision scheme of our facility indicates TNO in hemodynamically stable patients with liver injury and no need for celiotomy. CT-scan is performed and injury grading evaluated. Angiographic embolization is done if contrast medium extravasation is present at CT-scan. Laparoscopy is suggested if ongoing bleeding with negative CT-scan for blushing.

RESULTS: Liver injury was detected in 34 of 452 severe trauma patients. Fifty percents of patients underwent TNO. In this group, bleeding control was achieved by angiographic embolization in 8 cases and by laparoscopy in 1. None of these patients needed celiotomy. None of TNO patients died.

CONCLUSIONS: In a trauma referral center TNO of liver injury is possible in about 50%. TNO in severe trauma is improved if a correct CT-scan evaluation at the admission is performed and angiography correctly applied. Laparoscopy is a useful adjunctive tool in control of bleeding.