Study of blunt trauma abdomen involving liver injuries based on grade of injury, management: a single centre study

Abstract

Background: Modern treatment of liver trauma is increasingly non-operative. Advantages of non-operative management include avoidance of non-therapeutic celiotomies and the associated cost and morbidity, fewer intra-abdominal complications compared to operative repair and reduced transfusion risks. It is associated with a low overall morbidity and mortality and does not result in increase in length of the hospital stay. The objectives was to study efficacy of non-operative management of blunt liver injury.Methods: Seventy patients were studied, out of which 59 were initially given a trial of non-operative management and 11 patients were immediately shifted to the operating room. Of the 59 patients initially considered for non-operative management, 5 of them became unstable hemodynamically and were operated. Any complications arising in patients in non-operative group were managed with the help of interventional radiological procedures.Results: Total 54 patients were managed successfully without operative intervention which included patients with higher grade of injuries. 11 patients were shifted to surgery on arrival as they did not respond to resuscitation measures. Mortality and morbidity were found to be higher in patients undergoing surgery. Also, number of transfusions required, ICU stay and total number of days in hospital were higher in operated group. High ISS, low BP at admission, higher grade of injury in this study were seen in patients who failed non-operative management.Conclusions: Non-operative management is the initial management of choice in hemodynamically stable patients, irrespective of the grade of injury and is associated with less mortality and morbidity.