The liver is one of most commonly injured organs in blunt abdominal trauma. Improvement of diagnostic imaging, interventional radiology techniques and intensive care have turned conservative non-operative management into the elective treatment for up to 80-95% of liver trauma. Hemodynamic status, associated injuries, and anatomical liver injury grade are the main criteria for management decision-making.
CT scan with intravenous contrast is the gold standard in hemodynamically stable patients, while Focused Assessment with Sonography for Trauma patients (FAST) is a rapid examination detecting intra-abdominal free fluid.
Regardless of the grade of the injury, hemodynamically stable patients are candidates for conservative treatment, including angioembolization techniques and interval laparoscopy. Severe injuries must be controlled by intensive surveillance and are at increased risk of conservative treatment failure.
By contrast, hemodynamically unstable patients, non-responder patients and transient responder patients without optimal settings should undergo urgent laparotomy and, on many occasions, damage control surgery.
Angioembolization may be considered a first-line intervention in hemodynamically stable patients with arterial blush on CT scan. Moreover, post-operative angioembolization is indicated both after initial operative haemostasis in stable patients with contrast blush ad completion CT scan, and as adjunctive haemostatic tool with uncontrolled suspected arterial bleeding despite emergency laparotomy and haemostasis attempt. Recent evidence suggests that routine use of immediate post-damage control hepatic angiography reduces mortality in grade IV and V hepatic injuries.
Mandatory late follow-up imaging is not indicated and it should be used only if the patient’s clinical condition and symptoms indicating a complication require it for diagnosis. Complications such as liver abscesses, pseudoaneurysm and biliary fistula may appear in 10-15% of patients, but they can usually be managed with percutaneous or endoscopic procedures.
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