The current nonoperative paradigm in adults was stimulated by the success of nonoperative management of solid organ injuries in hemodynamically stable children. Despite the explosion of literature on this topic, many questions regarding nonoperative management of blunt hepatic injuries remain without conclusive answers in the literature.ĭuring the last century, the management of blunt force trauma to the liver has changed from observation and expectant management in the early part of the 1900s to operative intervention, to the current practice of selective operative and nonoperative management. Adjunctive therapies like angiography, percutaneous drainage, endoscopy/endoscopic retrograde cholangiopancreatography and laparoscopy remain important adjuncts to nonoperative management of hepatic injuries. Repeated imaging should be guided by a patient’s clinical status. Intravenous contrast enhanced computed tomographic scan is the diagnostic modality of choice for evaluating blunt hepatic injuries. Patients presenting with hemodynamic instability and peritonitis still warrant emergent operative intervention.
BLUNT INJURY TO THE HEPATIC FLEXTURE SERIAL
Nonoperative management of blunt hepatic injuries should only be considered in an environment that provides capabilities for monitoring, serial clinical evaluations, and an operating room available for urgent laparotomy. Nonoperative management of blunt hepatic injuries currently is the treatment modality of choice in hemodynamically stable patients, irrespective of the grade of injury or patient age. Most original hepatic guidelines remained valid and were incorporated into the greatly expanded current guidelines as appropriate. One hundred seventy-six articles were reviewed, of which 94 were used to create the current practice management guideline for the selective nonoperative management of blunt hepatic injury. The search was designed to identify English-language citations published after 1996 (the last year included in the previous guideline) using the keywords liver injury and blunt abdominal trauma.
The National Library of Medicine and the National Institutes of Health MEDLINE database were searched using PubMed ( ). Since that time, a large volume of literature on these topics has been published requiring a reevaluation of the previous Eastern Association for the Surgery of Trauma guideline.
These issues were first addressed by the Eastern Association for the Surgery of Trauma in the Practice Management Guidelines for Nonoperative Management of Blunt Injury to the Liver and Spleen published online in 2003.
ĭuring the last century, the management of blunt force trauma to the liver has changed from observation and expectant management in the early part of the 1900s to mainly operative intervention, to the current practice of selective operative and nonoperative management. Stassen, MD, Department of Surgery, University of Rochester, 601 Elmwood Ave, Box SURG, Rochester, NY 14642 email.
Direct URL citations appear in the printed text, and links to the digital files are provided in the HTML text of this article on the journal’s Web site ( Address for reprints: Nicole A. Supplemental digital content is available for this article. From the Department of Surgery (M.C.), Northwestern University, Chicago, Illinois Department of Surgery (N.A.S., J.D.C., A.S.), University of Rochester, Rochester, New York Department of Surgery (R.F.), University of Arizona, Tucson, Arizona Department of Surgery (O.G.), Vanderbilt University, Nashville and Department of Surgery (B.L.Z.), University of Tennessee Health Science Center, Memphis, Tennessee Department of Surgery (R.J.), University of Nebraska, Omaha, Nebraska Department of Surgery (A.M., K.S.), Yale University, New Haven, Connecticut Borgess Trauma Services (T.J.R.), Kalamazoo, Michigan Department of Surgery (M.S.), Cooper Health System, Camden, New Jersey Department of Surgery (K.M.T.), Wright State University, Dayton, Ohio and Department of Surgery (I.B., A.K.), College of Medicine, University of Florida, Jacksonville, Florida.
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