Current status of nonoperative management of liver injuries

The successful use of nonoperative management of liver injuries requires a hemodynamically stable patient and early access to computed tomography (CT). Extensive intraperitoneal blood and extravasation of contrast on CT predict potential clinical failures. The CT appearance of the liver injury has poor correlation with clinical outcome. Angiographic embolization complements nonoperative management in the stable patient with an ongoing blood requirement. The follow-up CT scan is not required provided the hematocrit and the patient's clinical status remain stable. Common errors in nonoperative management include attributing evidence of blood loss to nonhepatic sources and continuing transfusions in anticipation that the bleeding will stop without intervention.