Blunt trauma liver-conservative or surgical management?

Aim: To describe current evidence and guidelines that support non-surgical management of liver injuries in blunt trauma. The liver is the most commonly injured organ in blunt abdominal trauma and the second most commonly injured organ in penetrating abdominal trauma.Hepatic trauma is a common cause for admissions in the Emergency Room. Currently, non-surgical management is the standard treatment in hemodynamically stable patients with a success rate of around 85–98%. In the past, most liver injuries were treated surgically. The liver is a highly vascular organ located in the right upper quadrant of the abdomen and is susceptible to injury from traumatic mechanisms. Method: Authors reviewed 30 articles and literature search forcurrent evidence and guidelines that support non-surgical management of liver injuries in blunt trauma. The articles publication date was from 1986 to 2015. Result: Most blunt trauma livers (80% in adults and 97% in children) are treated conservatively 7,8In the literature, blunt liver trauma is associated with spleen injury in 45% of patients. Rib fractures are associated with injury to the right superior aspect of the liver in 33% of patients. Conclusion: Most blunt trauma livers (80% in adults and 97% in children) are treated conservatively, hemodynamic stable patients can be managed safely non-operatively, while urgent surgery continues to be the standard for hemodynamic compromised patients with hepatic trauma. Low grade injuries can be managed non-operatively with excellent results. Today non-surgical management is the standard treatment in hemodynamically stable patients with a success rate of around 85–98%. Mortality and morbidity can be significant in high-grade injuries. The overall complications are < 7% but can be as high as 15 to 20% in high-grade injuries. NOP management does not lead to longer hospital stay.