The role of non-operative management (NOM) in blunt hepatic trauma

NOM in blunt hepatic trauma is the preferred treatment in otherwise stable patients. To evaluate the role of NOM in blunt hepatic trauma, avoiding unnecessary surgery. Forty-four patients who presented with blunt hepatic trauma were admitted to the Emergency Unit. The patients were evaluated clinica...

Full description

Saved in:

Bibliographic Details
Published in:	Alexandria journal of medicine Vol. 49; no. 3; pp. 223 - 227
Main Authors:	Azzam, Ayman Zaki, Gazal, Abdel Hamid, Kassem, Mohammed I., Souror, Magdy A.
Format:	Journal Article
Language:	English
Published:	Elsevier B.V 01-09-2013 Taylor & Francis Taylor & Francis Group
Subjects:	Blunt liver trauma Failure of non operative management Non operative management Failure of non operative management Non operative management Blunt liver trauma
Online Access:	Get full text
Tags:	Add Tag No Tags, Be the first to tag this record!

Description
Summary:	NOM in blunt hepatic trauma is the preferred treatment in otherwise stable patients. To evaluate the role of NOM in blunt hepatic trauma, avoiding unnecessary surgery. Forty-four patients who presented with blunt hepatic trauma were admitted to the Emergency Unit. The patients were evaluated clinically. Abdominal computerized tomography was done to all hemodynamically stable patients and who were stabilized by the initial resuscitation. Staging of liver injury was done according to the scoring of the American Association for the Surgery of Trauma (AAST). Initially, all patients were treated conservatively and the patients who needed laparotomy later were considered as failure of NOM. Liver injuries due to penetrating causes were excluded. An informed consent was taken from each patient. Blunt trauma was the mechanism of injury in 44 patients (60.2%) including road traffic accidents in 42.5%. The peak age was between 20 and 30 years. The male to female ratio was 10:1. The majority of patients have multiple injuries with 10% having isolated liver injury. Thirty-six patients (82%) had one or more associated extra-abdominal injuries. Surgery was indicated in 14 patients (32%). The mean admission systolic pressure was lower in the NOM failure group (90 vs. 122 mmHg with p < 0.04). Complications occurred more in the operative group, chest infection occurred in 21.4% with a p value of 0.001, hyperpyrexia occurred in 21.4% with a p value of 0.001, and wound infection in 14.2% with a p value of 0.025. Mortality occurred in 7 patients. The cause of death in patients with blunt hepatic trauma was liver related in 2 patients due to hemorrhage and DIC. NOM in blunt hepatic trauma is the preferred treatment in otherwise stable patients. The factors that can suspect failure of NOM were the development of hemodynamic instability or the presence of associated injury that mandates immediate exploration.
ISSN:	2090-5068 2090-5076
DOI:	10.1016/j.ajme.2012.10.003