title: Nonoperative management of blunt hepatic injury: an Eastern Association for the Surgery of Trauma practice management guideline.
abstract: BACKGROUND
  During the last century, the management of blunt force trauma to the liver has changed from observation and expectant management in the early part of the 1900s to mainly operative intervention, to the current practice of selective operative and nonoperative management. These issues were first addressed by the Eastern Association for the Surgery of Trauma in the Practice Management Guidelines for Nonoperative Management of Blunt Injury to the Liver and Spleen published online in 2003. Since that time, a large volume of literature on these topics has been published requiring a reevaluation of the previous Eastern Association for the Surgery of Trauma guideline.
  
  
  METHODS
  The National Library of Medicine and the National Institutes of Health MEDLINE database were searched using PubMed (http://www.pubmed.gov). The search was designed to identify English-language citations published after 1996 (the last year included in the previous guideline) using the keywords liver injury and blunt abdominal trauma.
  
  
  RESULTS
  One hundred seventy-six articles were reviewed, of which 94 were used to create the current practice management guideline for the selective nonoperative management of blunt hepatic injury.
  
  
  CONCLUSIONS
  Most original hepatic guidelines remained valid and were incorporated into the greatly expanded current guidelines as appropriate. Nonoperative management of blunt hepatic injuries currently is the treatment modality of choice in hemodynamically stable patients, irrespective of the grade of injury or patient age. Nonoperative management of blunt hepatic injuries should only be considered in an environment that provides capabilities for monitoring, serial clinical evaluations, and an operating room available for urgent laparotomy. Patients presenting with hemodynamic instability and peritonitis still warrant emergent operative intervention. Intravenous contrast enhanced computed tomographic scan is the diagnostic modality of choice for evaluating blunt hepatic injuries. Repeated imaging should be guided by a patient's clinical status. Adjunctive therapies like angiography, percutaneous drainage, endoscopy/endoscopic retrograde cholangiopancreatography and laparoscopy remain important adjuncts to nonoperative management of hepatic injuries. Despite the explosion of literature on this topic, many questions regarding nonoperative management of blunt hepatic injuries remain without conclusive answers in the literature.
authors.affiliation: Department of Surgery, Northwestern University, Chicago, Illinois, USA. nicole_stassen@urmc.rochester.edu
authors.forename: Nicole A
authors.initials: NA
authors.lastname: Stassen
authors.forename: Indermeet
authors.initials: I
authors.lastname: Bhullar
authors.forename: Julius D
authors.initials: JD
authors.lastname: Cheng
authors.forename: Marie
authors.initials: M
authors.lastname: Crandall
authors.forename: Randall
authors.initials: R
authors.lastname: Friese
authors.forename: Oscar
authors.initials: O
authors.lastname: Guillamondegui
authors.forename: Randeep
authors.initials: R
authors.lastname: Jawa
authors.forename: Adrian
authors.initials: A
authors.lastname: Maung
authors.forename: Thomas J
authors.initials: TJ
authors.lastname: Rohs
authors.forename: Ayodele
authors.initials: A
authors.lastname: Sangosanya
authors.forename: Kevin
authors.initials: K
authors.lastname: Schuster
authors.forename: Mark
authors.initials: M
authors.lastname: Seamon
authors.forename: Kathryn M
authors.initials: KM
authors.lastname: Tchorz
authors.forename: Ben L
authors.initials: BL
authors.lastname: Zarzuar
authors.forename: Andrew
authors.initials: A
authors.lastname: Kerwin
mesh_terms: D004621:Embolization, Therapeutic; D006801:Humans; D015601:Injury Severity Score; D007813:Laparotomy; D008099:Liver / Q000000981:diagnostic imaging / Q000293:injuries* / Q000601:surgery; D014057:Tomography, X-Ray Computed; D014949:Wounds, Nonpenetrating / Q000000981:diagnostic imaging / Q000601:surgery / Q000628:therapy*