[Nonoperative management of traumatic liver injuries].
BACKGROUND
Nonoperative management (TNO) of traumatic liver injury is the choice in hemodinamically stable patients without other abdominal injuries requiring celiotomy, apart from liver injury grading and amount of free peritoneal blood. CT-scan and angiographic embolization availability increase TNO feasibility.


OBJECTIVE
To investigate feasibility of TNO in 16-months period consecutive liver injuries.


METHODS
All data of severe trauma patients admitted to our facility during the study period were recorded. Clinical decision scheme of our facility indicates TNO in hemodynamically stable patients with liver injury and no need for celiotomy. CT-scan is performed and injury grading evaluated. Angiographic embolization is done if contrast medium extravasation is present at CT-scan. Laparoscopy is suggested if ongoing bleeding with negative CT-scan for blushing.


RESULTS
Liver injury was detected in 34 of 452 severe trauma patients. Fifty percents of patients underwent TNO. In this group, bleeding control was achieved by angiographic embolization in 8 cases and by laparoscopy in 1. None of these patients needed celiotomy. None of TNO patients died.


CONCLUSIONS
In a trauma referral center TNO of liver injury is possible in about 50%. TNO in severe trauma is improved if a correct CT-scan evaluation at the admission is performed and angiography correctly applied. Laparoscopy is an useful adjunctive tool in control of bleeding.
Chiara
Osvaldo
O
S.S.D. Trauma Team, Ospedale "Niguarda - Cà Granda", Milano. ochiara@yahoo.com
Cimbanassi
Stefania
S
Bini
Roberto
R
Pavesi
Lucia
L
Rampoldi
Antonio
A
Colombo
Fabio
F
Sansonna
Fabio
F
Pugliese
Raffaele
R
D000328:Adult; D000465:Algorithms; D000792:Angiography; D003627:Data Interpretation, Statistical; D004621:Embolization, Therapeutic; D005240:Feasibility Studies; D005260:Female; D006801:Humans; D015601:Injury Severity Score; D010535:Laparoscopy; D008099:Liver / Q000000981:diagnostic imaging / Q000293:injuries*; D008297:Male; D008875:Middle Aged; D009104:Multiple Trauma / Q000628:therapy*; D014057:Tomography, X-Ray Computed; D014193:Trauma Centers