Efficacy and safety of non-operative management of blunt liver trauma

Abstract

Non-operative management is the treatment of choice for polytraumatized patients with blunt liver trauma who are hemodynamically stable. Non-operative management is an effective and safe treatment strategy. However, patients with an RTS score under 7.8 and other intra-abdominal non-liver injuries are at increased risk for an immediate surgical intervention.

Factores asociados a falla en el manejo no operatorio de lesiones hepáticas o esplénicas secundarias a trauma abdominal cerrado en niños

“…In our study, it was evidenced that despite having these resources (FAST echo in 4.47% of cases and conventional ultrasound in 28.4%), they are almost not used in our area 35 . In the last 30-40 years, the NOM has been considered as a fundamental tool in the hepatic 17 and splenic lesions secondary to closed abdominal trauma management, supported by the use of CAT, along with a better knowledge of the pathophysiology of this type of injuries 1,4,[11][12][13][18][19][20][21] . The success rates reported in the pediatric population according to the different series were between 83-100% [15][16][17] , in agreement with our work, in which the success rate was 95.7%, being the main surgical indication the hemodynamic instability.…”

“…NOM could fail 12 . Certain conditions have been associated with this fact, such as severe hepatic or splenic lesions (IV-V), since the more severe the lesion, the greater the probability of hemodynamic instability or association with injury to other organs, the hemoperitoneum abundant (3-4 quadrants), pseudoaneurysms and/or leakage of radiological contrast IV in CAT 1,[12][13][14]24,27,28,36 .…”

“…The included patient should present hemodynamic stability, absence of signs of peritoneal irritation 1,4,9,10,12,13,18,19,23,28,29 , whose age were between 0-14 years old, with an initial NOM for hepatic or splenic trauma, no trauma to other solid organs or other voids rather than liver or spleen, which has required to proceed with surgery; patients who present evidence of tomographic images for classification of hepatic or splenic trauma and evidence of clinical and paraclinical data (Hb levels) in clinical history.…”

“…The spleen and liver are the most commonly injured intraabdominal organs in pediatric patients, similar to adult patients (28% and 30%, respectively), cases of closed abdominal trauma. In most cases, these lesions can be managed without surgery 6,[11][12][13][14][15][16] . This therapeutic approach is called non-operative Management (NOM) and it is defined as that management performed in the patient, after a primary and secondary revision and after the taking the relevant images, which support the decision of not perfoming surgery immediately 12,13 .…”

“…In most cases, these lesions can be managed without surgery 6,[11][12][13][14][15][16] . This therapeutic approach is called non-operative Management (NOM) and it is defined as that management performed in the patient, after a primary and secondary revision and after the taking the relevant images, which support the decision of not perfoming surgery immediately 12,13 . We propose in this study to determine if there are clinical, paraclinical and imaging factors associated with failure in the non-operative management of splenic and/or hepatic lesions secondary to closed abdominal trauma in the age group from 0 to 14 years of age.…”