BLUNT LIVER TRAUMA: THE EFFECTIVENESS AND EVOLUTION OF NON-OPERATIVE MANAGEMENT
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Keywords
Blunt, liver trauma, blunt abdominal trauma, conservative management of liver trauma
Abstract
Background: At present, patients who are hemodynamically stable and have experienced acute abdominal trauma are most effectively treated with nonoperative management (NOM) for small liver injury.
Aim: To analyze the effectiveness and evolution of non-operative management among patients with blunt liver trauma.
Patients and Methods: The study comprised 50 cases with blunt liver injuries treated at surgery department. Causes, locations and classifications of damage, clinical conditions, ultrasonographic and CT findings, concomitant injuries, laboratory results, treatment modalities (surgical or conservative), blood transfusions, complications and duration of hospitalization were documented and studied.
Results: The distribution of liver injury grades showed that lower-grade injuries were more commonly managed with non-operative management. However, the association between injury severity and the use of NOM wasn't statistically significant. A strong relationship was noted among hemodynamic stability and the choice of NOM. Patients managed non-operatively had significantly shorter hospital stays (10.95 ± 5.18 days). While those who required operative management had an extended hospital stay (16.37 ± 5.12 days). Persistent hemorrhage was the leading cause of NOM failure (38.4%). Bile peritonitis was responsible for 23.1% of failures, similar to missed hollow organ injuries.
Conclusion: Non-operative management of blunt liver injuries proved both safe and practicable in hemodynamically stable individuals. Hemodynamic instability and widespread peritonitis during resuscitation, or in conjunction with intra-abdominal organ damage, necessitate prompt surgical intervention.
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Ahmed Mohamed Said
Department of Surgery, Faculty of Medicine for Girls, Al-Azhar University, Egypt.
Rasha Abd Elaziz Abd Elghany
Department of Surgery, Faculty of Medicine for Girls, Al-Azhar University, Egypt.
Hany Abdelfatah El-Hady
Department of Surgery, Faculty of Medicine for Girls, Al-Azhar University, Egypt.
El-Sayed Mahmoud Abd-Elwahab
Department of Surgery, Faculty of Medicine for Girls, Al-Azhar University, Egypt.