Non-Operative Management of Isolated Blunt Liver Trauma – A single institute based study

Shamsul Bari; Shabir Hussain Rather

doi:10.33883/jms.v27i1.1324

Shamsul Bari Skims Medical College ,Srinagar
Shabir Hussain Rather

DOI: https://doi.org/10.33883/jms.v27i1.1324

Keywords: Blunt trauma, liver, Non-operative Management, Liver injury, CT scan

Abstract

Background: The liver and the spleen, despite being relatively shielded by the inferior ribs, represent commonly injured organs during abdominal blunt trauma and account for about two-thirds of all visceral injuries. Liver trauma is the most common abdominal emergency with high morbidity and mortality.

Aims and objective: To evaluate the safety and effectiveness of NOM (non-operative management) of blunt trauma liver following a standardized treatment protocol and to identify the factors predicting the failure of this treatment.

Methods: The study was conducted in the Department of surgery Skims Medical College, Srinagar for a period of two years from February 2019 to March 2021 and all the patients with USG and CT-documented blunt trauma liver injury were included in the study. History taking, laboratory investigations and resuscitation were performed simultaneously along with ultrasound and CT scan. Data regarding the mechanism of trauma, grade of liver injury, method of intervention (non-operative) and outcome were collected, tabulated and analysed using proper statistical methods.

Results: A total of 43 cases with a diagnosis of isolated blunt hepatic injuries were included in the study. In our study, mostly young patients were involved with a mean age of 24.19+14.65 years, which included 30 (69.7%) males and 13 (30.3%) females. Non-operative management was adopted in 38 patients (88.3%), while as 5 (11.6%) patients needed an operative management. Most cases of liver trauma were found to be grade-III hepatic injury occurring in 20 out of 43 patients (41.1%). The morbidity rate was significantly associated with the severity of injury (grade IV and V).

Conclusion: Non-operative management of liver injuries is safe and effective in selected patients and reduces optimal length of stay without increasing morbidity or mortality. These patients may be safely discharged in the presence of a normal abdominal examination and haemodynamic stability. Morbidity and mortality in grade IV and V liver trauma is significantly high and early operative intervention is recommended in these patients.

Keywords: Blunt trauma, liver, Non-operative Management, Liver injury, CT scan

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References

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