Abstract
IntroductionThe treatment of complex liver injuries remains a challenge. Nonoperative treatment for such injuries is increasingly being adopted as the initial management strategy. We reviewed our experience, at a University teaching hospital, in the nonoperative management of grade IV liver injuries with the intent to evaluate failure rates; need for angioembolization and blood transfusions; and in-hospital mortality and complications.MethodsThis is a retrospective analysis conducted at a single large trauma centre in Brazil. All consecutive, hemodynamically stable, blunt trauma patients with grade IV hepatic injury, between 1996 and 2011, were analyzed. Demographics and baseline characteristics were recorded. Failure of nonoperative management was defined by the need for surgical intervention. Need for angioembolization and transfusions, in-hospital death, and complications were also assessedResultsEighteen patients with grade IV hepatic injury treated nonoperatively during the study period were included. The nonoperative treatment failed in only one patient (5.5%) who had refractory abdominal pain. However, no missed injuries and/or worsening of bleeding were observed during the operation. None of the patients died nor need angioembolization. No complications directly related to the liver were observed. Unrelated complications to the liver occurred in three patients (16.7%); one patient developed a tracheal stenosis (secondary to tracheal intubation); one had pleural effusion; and one developed an abscess in the pleural cavity. The hospital length of stay was on average 11.56 days.ConclusionsIn our experience, nonoperative management of grade IV liver injury for stable blunt trauma patients is associated with high success rates without significant complications.
Highlights
The treatment of complex liver injuries remains a challenge
One of the most significant advances in the management of trauma patients in recent years was the introduction of Computed Tomography (CT) scan for stable patients
The goal of this study was to determine the effectiveness of nonoperative management of grade IV liver injuries evaluating failure rates; need for angioembolization and blood transfusions; and in-hospital morbidity and mortality
Summary
The treatment of complex liver injuries remains a challenge. Nonoperative treatment for such injuries is increasingly being adopted as the initial management strategy. The treatment of complex liver injuries remains a challenge for surgeons despite the last decade’s advances in diagnostic and therapeutic techniques. The nonoperative treatment for such injuries in hemodynamically stable patients with blunt abdominal trauma. CT scan, due to its high sensitivity, specificity and accuracy, is an important screening and diagnostic tool for intra-abdominal injuries in hemodynamically stable patients; patients with altered level of consciousness; and those with difficult clinical examination or associated pelvic fractures [9,10,11,12]
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