Solid Organ Injuries: To Irradiate or Operate?

Intra-abdominal solid organ injuries (SOI) represent a common and potentially life-threatening consequence in the traumatically injured patient. Advances in interventional radiology (IR) endovascular techniques have reformed the surgical management of these injuries into a multidisciplinary approach. The choice between endovascular and surgical management depends largely on the patient's hemodynamic status, injury grade, and risk of complications. Although individualized, surgery is reserved for most patients who are hemodynamically unstable, have peritonitis, hollow viscus injury, or are refractory to IR intervention. IR intervention can be attempted in cases of active extravasation or SOI with high-risk imaging features. However, in complex liver trauma, combined management with surgery and IR has been shown to reduce mortality. This review synthesizes recent advances and evidence-based practices for managing SOI, emphasizing the role of IR as an adjunct to surgical management and complication resolution.