The current management of hepatic trauma

Nonoperative treatment is best for hemodynamically stable patients with blunt liver injuries and in selected patients with penetrating injuries. However, most patients with penetrating injuries require early surgical intervention to control life-threatening hemorrhage or manage associated injuries. It is important to determine early in the course of operation if an abbreviated laparotomy and packing are indicated. In patients with persistent hemorrhage that cannot be controlled by surgical means, immediate transfer to the angiography suite for selective embolization may be a lifesaving alternative. Surgeons should not hesitate to operate on a patient for complications, but many of these can be managed by delayed, less-invasive procedures such as angiography, CT-guided drainage of collections, laparoscopy, or endoscopic retrograde cholangiopancreatography.