Nichtoperatives Management stumpfer Leber- und Milzverletzungen – Praktische Aspekte und Stellenwert radiologischer Scoring-Systeme

Margot Fodor,Benno Cardini,Stefan Stättner,Matthias Haselbacher,Dagmar Morell-Hofert,Eva Braunwarth,Dietmar Öfner,Eva Gassner,Florian Primavesi

doi:10.1007/s10353-018-0545-x

Margot Fodor, Benno Cardini + Show 7 more

Open Access

https://doi.org/10.1007/s10353-018-0545-x

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Abstract

SummaryBackgroundNon-operative management (NOM) of blunt hepatic and splenic injuries has become popular in haemodynamically stable adult patients, despite uncertainty about efficacy, patient selection, and details of management. Up-to-date strategies and practical recommendations are presented.MethodsA selective literature search was conducted in PubMed and the Cochrane Library (1989–2016).ResultsNo randomized clinical trial was found. Non-randomized controlled trials and large retrospective and prospective series dominate. Few systematic reviews and meta-analyses are available. NOM of selected patients with blunt liver and spleen injuries is associated with low morbidity and mortality. Only data of limited evidence are available on intensity and duration of patient monitoring, repeat imaging, antithrombotic prophylaxis and return to normal activity. There is high-level evidence on early mobilisation and post-splenectomy vaccination.ConclusionNOM of blunt liver or spleen injuries is a worldwide trend, but the literature does not provide high-grade evidence for this strategy.

Highlights

Blunt abdominal trauma is very common in central European emergency departments, especially due to sports activities
Due to frequent postoperative complications after primary surgical treatment in the past, a paradigm shift to Non-operative management (NOM) in haemodynamically stable patients has emerged in major trauma centres [3, 4], where NOM has been described as a safe procedure when twenty-four-seven availability of experienced surgeons, modern imaging modalities, intensive care units (ICU) and other support services [5] is assured
The results indicated that even major hepatic injury assessed with preoperative CT can usually be managed without surgery in haemodynamically stable patients [18]

Summary

Introduction

Blunt abdominal trauma is very common in central European emergency departments, especially due to sports activities. Management of these injuries can be challenging because of the frequent association with a complex clinical picture of abdominal, thoracic, limb and head trauma [1, 2]

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