title: Selective non-operative management of penetrating liver injuries at a UK tertiary referral centre.
abstract: BACKGROUND
  Selective non-operative management (SNOM) of penetrating abdominal injuries has increasingly been applied in North America in the last decade. However, there is less acceptance of SNOM among UK surgeons and there are limited data on UK practice. We aimed to review our management of penetrating liver injuries and, specifically, the application of SNOM.
  
  
  METHODS
  A retrospective review was performed of patients presenting with penetrating liver injuries between June 2005 and November 2013.
  
  
  RESULTS
  Thirty-one patients sustained liver injuries due to penetrating trauma. The vast majority (97%) were due to stab wounds. The median injury severity score was 14 and a quarter of patients had concomitant thoracic injuries. Twelve patients (39%) underwent immediate surgery owing to haemodynamic instability, evisceration, retained weapon or diffuse peritonism. Nineteen patients were stable to undergo computed tomography (CT), ten of whom were selected subsequently for SNOM. SNOM was successful in eight cases. Both patients who failed SNOM had arterial phase contrast extravasation evident on their initial CT. Angioembolisation was not employed in either case. All major complications and the only death occurred in the operatively managed group. No significant complications of SNOM were identified and there were no transfusions in the non-operated group. Those undergoing operative management had longer lengths of stay than those undergoing SNOM (median stay 6.5 vs 3.0 days, p<0.05).
  
  
  CONCLUSIONS
  SNOM is a safe strategy for patients with penetrating liver injuries in a UK setting. Patient selection is critical and CT is a vital triage tool. Arterial phase contrast extravasation may predict failure of SNOM and adjunctive angioembolisation should be considered for this group.
authors.affiliation: Nottingham University Hospitals NHS Trust, UK.
authors.forename: P
authors.initials: P
authors.lastname: MacGoey
authors.forename: A
authors.initials: A
authors.lastname: Navarro
authors.forename: I J
authors.initials: IJ
authors.lastname: Beckingham
authors.forename: I C
authors.initials: IC
authors.lastname: Cameron
authors.forename: A J
authors.initials: AJ
authors.lastname: Brooks
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D005260:Female; D006801:Humans; D015601:Injury Severity Score; D008099:Liver / Q000000981:diagnostic imaging / Q000293:injuries*; D008297:Male; D008875:Middle Aged; D018579:Patient Selection; D012189:Retrospective Studies; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome; D014950:Wounds, Penetrating / Q000000981:diagnostic imaging / Q000628:therapy*; D014951:Wounds, Stab / Q000000981:diagnostic imaging / Q000628:therapy; D055815:Young Adult