Published October 31, 2008 | Version v1
Presentation Open

Management of Blunt Liver Trauma.

Authors/Creators

Description

Background: Blunt liver trauma, a leading cause of intra-abdominal injury in polytrauma patients, underscores the need for tailored strategies. While nonoperative protocols have become the standard for stable patients, it is the unique clinical settings and the expertise of healthcare providers that can truly optimize outcomes.

Objective: To analyze our center’s experience in the management of blunt liver trauma and assess the feasibility of modern treatment algorithms, which include [specific details about the algorithms], in routine practice.

Material and Methods: We conducted a retrospective review of 70 consecutive patients admitted with blunt abdominal trauma from January 2006 to January 2007. Collected data included demographics, mechanism of injury, associated solid-organ injuries, hemodynamic status on presentation, treatment modality (nonoperative vs operative), and injury distribution.

Results: Of the 70 patients, 57 (81%) were male and 13 (19%) were female. The breakdown of solid-organ injuries was as follows: Spleen in 27 patients (38%); liver in 32 patients (45%); kidney in 8 patients (11%); and pancreas in 3 patients (4%). Injury combinations were as follows: isolated liver injury in 38 cases (54%), two-organ injuries in 26 cases (37%), and three or more organs in 6 cases (9%).

Nonoperative management (NOM) was applied to 27 hemodynamically stable patients (38%), all of whom remained free of delayed hemorrhage under serial clinical and imaging surveillance. This success story of NOM in managing blunt liver trauma gives hope for further advancements. Operative management (OM) was required in 43 patients (62%) due to persistent instability or concurrent injuries.

Conclusion: At our institution, operative intervention was performed in two-thirds of blunt liver trauma cases, primarily driven by hemodynamic instability and multiple-organ involvement. Incorporating standardized NOM algorithms—based on stability, injury grade, comorbidities, and time to admission—could safely increase the rate of conservative treatment in suitable patients.

Files

Agron Dogjani - Management of Blunt Liver Trauma..jpeg

Files (218.4 kB)

Additional details

References

  • Agron Dogjani. (2005, October 10). Treatment of BAT (Blunt Abdominal Trauma). 1st Congress of Medical Students and New Doctors of Military Medicine., Bucharest, Rumania, https://doi.org/10.5281/zenodo.15733463
  • Moore, E. E., Cogbill, T. H., Jurkovich, G. J., Shackford, S. R., Malangoni, M. A., & Champion, H. R. (1989). Organ injury scaling: Spleen, liver, and kidney. Journal of Trauma, 29(12), 1664–1666. https://doi.org/10.1097/00005373-198912000-00013
  • Pachter, H. L., Knudson, M. M., Esrig, B., Ross, S., Hoyt, D., Cogbill, T., Sherman, H., Scalea, T., Harrison, P., Shackford, S., Pachter, H. L., Knudson, M. M., Esrig, B., Ross, S., Hoyt, D., Cogbill, T., Sherman, H., Scalea, T., Harrison, P., & Shackford, S. (2000). The current status of nonoperative management of adult blunt hepatic injuries. American Journal of Surgery, 179(5), 442–449. https://doi.org/10.1016/S0002-9610(00)00369-0
  • Fabian, T. C., Croce, M. A., Stanford, G. G., Payne, L. W., Mangiante, E. C., Voeller, G. R., & Kudsk, K. A. (1991). Hepatic trauma: 193 patients with grade III to VI injuries managed without resection or packing. Annals of Surgery, 213(6), 538–545. https://doi.org/10.1097/00000658-199106000-00002
  • Dogjani, A., Lila, A., Zikaj, G. "Evaluation of Damage Solid Organ in Patient with Blunt Abdomen Trauma (BAT)." 1st Joint Congress EATES & ETS, May 23-26.2007 Graz, Austria. DOI: http://dx.doi.org/10.13140/RG.2.2.30993.97123/1