Non-operative management of liver trauma

Abstract

Aim-Background: Non-operative management (NOM) of liver trauma is well-established and accepted in current clinical practice. Initially considered as appropriate for lower grades of injury, NOM is now widely preferred for moderate and severe liver injuries too. Methods: This review is based on a search of the English literature in Pubmed, using terms such as “liver trauma” and “non-operative”. Reconsideration of currently used indications and selection criteria for the non-operative management of liver trauma, as well as therapeutic strategies, complications and patient outcome, are discussed. Results: Appropriate selection of patients according to the following criteria is essential for the successful outcome of NOM: haemodynamic stability (on arrival or after initial resuscitation), the absence of associated injuries to intra- or retro-peritoneal organs necessitating operative intervention, and the availability of a multidisciplinary team including an experienced radiologist, an experienced liver (preferably) surgeon and intensive care facilities. The volume of haemoperitoneum and the grade of injury are not considered factors that preclude NOM. Of paramount importance is the monitoring of signs of peritonitis, related to a possible unrecognised hollow viscus injury, which is appropriately managed operatively. Computed tomography is also important for early diagnosis of ongoing bleeding, in order to intervene either angiographically (embolization) or operatively (haemostasis). Mortality during NOM varies between 0.4% (liver-related) up to 13% (associated injuries). Conclusions: In conclusion, the main selection criterion of patients with liver trauma for NOM is haemodynamic stability, independent of the grade of injury and the volume of haemoperitoneum. Accurate