Selective Non Operative Management of Blunt Liver Trauma: Is It Still a Challenge?
Journal of Surgery
Volume 5, Issue 6, December 2017, Pages: 93-96
Received: Sep. 18, 2017;
Accepted: Oct. 8, 2017;
Published: Nov. 10, 2017
Views 1986 Downloads 133
Mohammed Abdallah Hablus, General Surgery Department, Faculty of Medicine, Tanta University Hospital, Tanta, Egypt
Amir Fawzy Abdelhamid, General Surgery Department, Faculty of Medicine, Tanta University Hospital, Tanta, Egypt
Mahmoud Mostafa Alsherief, General Surgery Department, Faculty of Medicine, Tanta University Hospital, Tanta, Egypt
Osama Hasan Abd-Raboh, General Surgery Department, Faculty of Medicine, Tanta University Hospital, Tanta, Egypt
Follow on us
The non-therapeutic laparotomy in managing cases with blunt liver injuries is not without risks, so selective non-operative treatment in stable patients was tried in many centers and has become the standard of care of these patients The aim of this study was to assess the feasibility and safety of selective non-operative management of blunt liver injury in our institution Patients and Methods: This prospective study was conducted on 40 patients with blunt liver injury who met our inclusion criteria admitted to Tanta University Hospital during the period from January 2012 to January 2014. All patients were treated by selective non-operative treatment (repeated clinical examination, serial U/S and CT study and follow up) Results: The age of our patients ranged from 26 to 40 years with a mean (±SD) of 31.3 ± 3.77 years. 36 patients were males (90%), while 4 patients (10%), were female. Total length of stay was ranged from 2 days to 15 days with a mean (±SD) of 5.8 ± 3.27 days as regards all cases. Intensive care unit stay was in 2 cases (5%) which FNOM with mean (±SD) of 1.5 ± 0.7 days. CT study was done in all cases (100%), 2 cases (5%) was operated after 6 hours of conservatism in ICU due to hemodynamic instability after initial assessment of stability. Conclusions: Selective non operative management of blunt liver injury in bunt abdominal trauma is safe, efficient, and cost-effective in the appropriate clinical setting and can lead to fewer unnecessary laparotomies in patients with liver injury. Proper patient selection, resources that permit close observation, and frequent abdominal examinations are paramount in obtaining the best results.
Selective Non-operative Management, Radiological Grading, Blunt Liver Trauma
To cite this article
Mohammed Abdallah Hablus,
Amir Fawzy Abdelhamid,
Mahmoud Mostafa Alsherief,
Osama Hasan Abd-Raboh,
Selective Non Operative Management of Blunt Liver Trauma: Is It Still a Challenge?, Journal of Surgery.
Vol. 5, No. 6,
2017, pp. 93-96.
Copyright © 2017 Authors retain the copyright of this article.
This article is an open access article distributed under the Creative Commons Attribution License (http://creativecommons.org/licenses/by/4.0/
) which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
Ahmed N, vernik JJ. Management of liver trauma in adults. J of Emergencies, Trauma and Shock 2011; 4: 114-9.
Christmas AB, Wilson AK, Manning B et al. selective management of blunt hepatic injuries including non-operative management is a safe and effective strategy. Surgery 2005; 138 (4): 606–10.
Peitzman AB, schwab CW, yealy DM et al. the trauma manual: Trauma and active care surgery. Lippincott Manuel series (formly known as the spiral manual series) 2012; 4th ed.
Richordson HD, Granklin GA, hekon K I, et al. Evolution in the management of hepatic trauma: 25 year perspective. Ann Surg. 2000; 232: 324-30.
Lucas CE, ledgerwood AN. Changing times and treatment of liver injury. Ann Surg. 2000; 66: 337–41.
Eastern Association for surgery of trauma. Practice management guidelines for the non operative management of blunt injury to the liver and spleen. 2003. Available at: http://www.east.org.accessed February 2005.
Kory S, Anita R, Skondorajah, et al. changing in the management of liver trauma leading to reduced mortality: 15 year experience in a major trauma centre ANZ J Surg. 2016; 86: 894–99.
Nirman G, Tingstedt B, Ekelund M, et al. Non-operative management of blunt liver trauma feasible and safe also in centers with a low trauma incidence. HPB2009; 11: 50–6.
Moore EE, Cogbilt TH, Jurkowich GJ. Et al, organ injury scaling: spleen and liver (1994 revision) American Association of Surgery of Trauma J of Trauma 1995; 38: 323–4.
Asensio JA, Roldan G, Petrone P, et al. operative and outcome in 103 AAST-OIS grades IV and V complex hepatic injuries. Journal of trauma 2003; 54: 647-53.
Buccoliero F, Ruscelli P.: Current trends in polytrauma management. Diagnostic and the rapeutic algorithms operational in the trauma centre of Cesena, Italy. Annali Italiani di chirurgia 2010; 81: 81-93.
Eastridge BJ Salinas J Schneider M, et al, Hypotension begins at 110 mm Hg redefining "hypotension" wuth data. Journal of trauma 2007; 63: 291-97.
Friedmann P. (2011): Selective management of stab wounds to the abdomen. Arch Surg 1968; 96: 292-295. Quated from JansenJO, Inaba K, Rizoli SB, et al; Selective non-operative management of penetrating abdominal injury in Great Britainand Ireland: survey of practice. Injury, Int. J. Care Injured; 4639: 1-6.
Clark D. L., thombson S. R., Madiba T. E. et al (2005): Selective conservation in trauma management: a south African contribution. World J Surg. 29(8): 962-965.
Navsaria P. H., Berli J. U. et al. (2007): Non-operative management of abdominal stab wounds- an analysis of 186 patients. S Afr J Surg; 45(4): 128-132.
Ali N. K., Hemant V., Sumatra M. D. and Muthusamy C. (2009):
Anderson I. E., Saghier M., Kneteman N. M. and Bigam D. L. (2004): Liver trauma: management of devascularization injuries. J. Trauma; 57: 1099-104.
Stawichi S. P. (2007): Trends in nonoperative management of traumatic injuries: S synopsis. OPUS 12 scientist; 1 (1): 19-35.
Bhavinder K. Arora, Rachit Arora, Akshit Arora (2016): Conservative treatment of blunt hepatic trauma: my experience. International Surgery Journal: 3(4) 2155-2159.