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Published on: July 28, 2020

Failure of nonoperative management of abdominal solid organ injuries

Dan A Galvan1, Andrew B Peitzman

  • 1Department of Critical Care Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania 15213, USA.

Current Opinion in Critical Care
|November 2, 2006
PubMed

Insights

Nonoperative management of blunt splenic injury is generally successful in children and adults. However, careful consideration of factors influencing failure rates is crucial to improve outcomes and avoid patient harm.

Area of Science:

  • Trauma Surgery
  • Pediatric Surgery
  • Surgical Management

Background:

  • Nonoperative management (NOM) of blunt splenic injury has been standard in pediatric surgery for 25 years.
  • NOM of blunt liver and spleen trauma became a template in adult trauma surgery.
  • NOM offers significant benefits to hemodynamically stable patients with blunt liver or splenic trauma.

Purpose of the Study:

  • To review the success and failure rates of nonoperative management for blunt splenic and liver injuries.
  • To identify factors influencing the success or failure of nonoperative management.
  • To discuss strategies for improving organ salvage and reducing failures in NOM.

Main Methods:

  • Review of recent literature on nonoperative management of blunt splenic and liver injuries.
  • Analysis of factors impacting success and failure rates.
  • Discussion of clinical judgment, imaging, and interventional techniques.

Main Results:

  • Factors influencing NOM success/failure include guidelines, postsplenectomy infection risk, clinical judgment, CT findings, multiple solid organ injuries, hollow viscus injury risk, and angioembolization drawbacks.
  • Despite documented failures, NOM has been generally successful for blunt splenic and liver trauma.
  • Ongoing efforts aim to enhance organ salvage and minimize NOM failures.

Conclusions:

  • Nonoperative management of blunt splenic and liver injuries is largely successful.
  • Continuous efforts are needed to improve organ salvage rates and reduce failure instances.
  • Balancing enthusiasm for NOM advancement with patient safety is paramount to avoid imperiling vulnerable subpopulations.
Abstract

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