title: Management of blunt hepatic trauma.
abstract: For the last 20 years, nonoperative management (NOM) of blunt hepatic trauma (BHT) has been the initial policy whenever this is possible (80% of cases), i.e., in all cases where the hemodynamic status does not demand emergency laparotomy. NOM relies upon the coexistence of three highly effective treatment modalities: radiology with contrast-enhanced computerized tomography (CT) and hepatic arterial embolization, intensive care surveillance, and finally delayed surgery (DS). DS is not a failure of NOM management but rather an integral part of the surgical strategy. When imposed by hemodynamic instability, the immediate surgical option has seen its effectiveness transformed by development of the concept of abbreviated (damage control) laparotomy and wide application of the method of perihepatic packing (PHP). The effectiveness of these two conservative and cautious strategies for initial management is evidenced by current experience, but the management of secondary events that may arise with the most severe grades of injury must be both rapid and effective.
authors: Clinique Universitaire de Chirurgie Digestive et de l'Urgence, Université Grenoble Alpes, CHU de Grenoble, BP 217, 38043 Grenoble cedex, France. Electronic address: CLetoublon@chu-grenoble.fr.
authors: C
authors: C
authors: Letoublon
authors: Clinique Universitaire de Chirurgie Digestive et de l'Urgence, Université Grenoble Alpes, CHU de Grenoble, BP 217, 38043 Grenoble cedex, France.
authors: A
authors: A
authors: Amariutei
authors: Clinique Universitaire de Chirurgie Digestive et de l'Urgence, Université Grenoble Alpes, CHU de Grenoble, BP 217, 38043 Grenoble cedex, France.
authors: N
authors: N
authors: Taton
authors: Clinique Universitaire de Chirurgie Digestive et de l'Urgence, Université Grenoble Alpes, CHU de Grenoble, BP 217, 38043 Grenoble cedex, France.
authors: L
authors: L
authors: Lacaze
authors: Clinique Universitaire de Chirurgie Digestive et de l'Urgence, Université Grenoble Alpes, CHU de Grenoble, BP 217, 38043 Grenoble cedex, France.
authors: J
authors: J
authors: Abba
authors: Clinique Universitaire de Chirurgie Digestive et de l'Urgence, Université Grenoble Alpes, CHU de Grenoble, BP 217, 38043 Grenoble cedex, France.
authors: O
authors: O
authors: Risse
authors: Clinique Universitaire de Chirurgie Digestive et de l'Urgence, Université Grenoble Alpes, CHU de Grenoble, BP 217, 38043 Grenoble cedex, France.
authors: C
authors: C
authors: Arvieux
mesh_terms: D004621:Embolization, Therapeutic; D006470:Hemorrhage / Q000628:therapy; D006801:Humans; D059325:Intra-Abdominal Hypertension; D008099:Liver / Q000293:injuries*; D008107:Liver Diseases / Q000628:therapy; D010532:Peritoneal Diseases / Q000628:therapy; D011182:Postoperative Care; D012086:Reoperation; D014057:Tomography, X-Ray Computed; D014949:Wounds, Nonpenetrating / Q000150:complications / Q000601:surgery / Q000628:therapy*
keywords: Abdominal compartment syndrome; Liver trauma; Perihepatic packing