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Liver Trauma: Until When We Have to Delay Surgery? A Review
Inés Cañas García1, Julio Santoyo Villalba2, Domenico Iovino3
1General and Digestive Surgery, Hospital Clínico San Cecilio of Granada, 18002 Granada, Spain.
Life (Basel, Switzerland)
|May 28, 2022
Summary
Blunt abdominal trauma can injure the liver, often with coexisting organ damage. Nonoperative management, including embolization and drainage, is preferred to avoid surgery and minimize liver damage and promote faster recovery.
Area of Science:
- Trauma Surgery
- Hepatology
- Abdominal Imaging
Background:
- Liver involvement is common in blunt abdominal trauma, frequently with associated spleen, kidney, or pancreas injuries.
- Traditional management often involved exploratory laparotomy, but modern approaches emphasize less invasive strategies when hemodynamically stable.
Purpose of the Study:
- To review the current strategies for managing liver injuries following blunt abdominal trauma.
- To highlight the role of nonoperative management and interventional radiology in optimizing patient outcomes.
Main Methods:
- Review of literature on blunt liver trauma management.
- Discussion of diagnostic modalities, including CT scan for lesion characterization.
- Emphasis on nonoperative management (NOM) principles and adjunctive interventions.
Main Results:
- Most liver trauma grades, except complete vascular avulsion, are amenable to nonoperative management.
- Interventions like embolization, percutaneous drainage, ERCP, and PTBD can effectively manage bleeding and biliary complications.
- NOM aims to limit damage-associated molecular patterns (DAMPs) release, reduce immune suppression, and prevent ischemic liver injury.
Conclusions:
- Nonoperative management is the preferred strategy for most blunt liver trauma cases.
- Interventional techniques are crucial for managing complications and avoiding or delaying surgery.
- This approach promotes faster recovery and minimizes liver damage from ischemia and surgical stress.
