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. 2019 Jan;7(1):49-54.
doi: 10.29252/beat-070107.

Non-Operative Management of Blunt Liver Trauma: Safety, Efficacy and Complications of a Standardized Treatment Protocol

Antonio Brillantino  1   2 , Francesca Iacobellis  3   2 , Patrizio Festa  1 , Arianna Mottola  1 , Ciro Acampora  3 , Fabio Corvino  4 , Santolo Del Giudice  1 , Michele Lanza  1 , Mariano Armellino  1 , Raffaella Niola  4 , Luigia Romano  3 , Maurizio Castriconi  1 , Maurizio De Palma  1 , Giuseppe Noschese  1
Affiliations

Non-Operative Management of Blunt Liver Trauma: Safety, Efficacy and Complications of a Standardized Treatment Protocol

Antonio Brillantino et al. Bull Emerg Trauma. 2019 Jan.

Abstract

Objective: To evaluate the safety and effectiveness of NOM (non-operative management) in the treatment of blunt liver trauma, following a standardized treatment protocol.

Methods: All the hemodynamically stable patients with computed tomography (CT) diagnosis of blunt liver trauma underwent NOM. It included strict clinical and laboratory observation, 48-72h contrast enhanced ultrasonography (CEUS) or CT follow-up, a primary angioembolization in case of admission CT evidence of vascular injuries and a secondary angioembolization in presence of vascular injuries signs at follow-up CEUS.

Results: 181 patients (85.4%) [55 (30.4%) women and 126 (69.6%) men, median age 39 (range 14-71)] were included. Of these, 63 patients (34.8%) had grade I, 48 patients (26.5%) grade II, 39 patients (21.5%) grade III, 21 patients (11.6%) grade IV and 10 patients (5.5%) grade V liver injuries. The overall success rate of NOM was 96.7% (175/181). There was not significant difference in the success rate between the patients with different liver injuries grade. Morbidity rate was 7.4% (13/175). Major complications (2 bilomas, 1 liver hematoma and 2 liver abscesses) were successfully treated by CEUS or CT guided drainage. Eighteen (18/181) patients (9.9%) underwent angioembolization with successful results.

Conclusion: Non-operative management of blunt liver trauma represents a safe and effective treatment for both minor and severe injuries, achieving an high success rate and an acceptable morbidity rate. The angiographic study with embolization, although required only in selected cases of vascular injuries, represents a fundamental therapeutic option in a significant percentage of patients.

Keywords: Angioembolization; Blunt trauma; Hepatic trauma; Liver injury; Non-operative management.

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Conflict of interest statement

None declared.

Figures

Fig. 1
Fig. 1
Flow-chart of the study design
Fig. 2
Fig. 2
Non-operative management (NOM) success rate in patients with different injury grades
See this image and copyright information in PMC

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