Nonoperative Management Guideline of Liver Injury

Yu, Hee Chul

Abstract

Management of liver injury has significant evolved over the last two decades. Operative management is the standard treatment in liver trauma. One of the major reasons for operative management of liver injury is ongoing hemorrhage. However, the majority of the liver injuries stop bleeding spontaneously, and computed tomography (CT) has become increasingly affordable and valuable. As a consequence of these changes, nonoperative management of isolated liver injury in a hemodynamically stable patient is reasonable. Criteria for nonoperative management of liver injuries include hemodynamic stability, absence of a clear indication for laparotomy such as peritoneal signs, low grade liver injuries, and transfusion requirements of less than two units of blood. These criteria have been challenged, and more broad indications have since been used, followed by serial hematocrit and vital signs rather than physical examination. Injury grade, hemoperitoneal degree, neurologic status, and presence of associated injuries are not contraindications to nonoperative management of liver injury. Abdominal CT is the most reliable test used to identify and assess the severity of blunt liver injuries. More recently, arteriography with embolization is a useful adjunct for nonoperative management prior to exploration in the hemodynamically stable liver injury patient who continues to bleed. Advantages of nonoperative management are: avoidance of non-therapeutic celiotomies, fewer intra-abdominal complications, reduced need for blood transfusion, and decreased overall morbidity and mortality as compared with operative management. In conclusion, the nonoperative management strategy is an acceptable and safe treatment modality for the care of liver injury but remain hemodynamically stable, irrespective of the grade of injury or hemoperitoneal degree.