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Brillantino A, Iacobellis F, Festa P, et al. Non-Operative Management of Blunt Liver Trauma: Safety, Efficacy and Complications of a Standardized Treatment Protocol. Bull Emerg Trauma. 2019;7(1):49-54doi: 10.29252/beat-070107.
Brillantino, A., Iacobellis, F., Festa, P., Mottola, A., Acampora, C., Corvino, F., Del Giudice, S., Lanza, M., Armellino, M., Niola, R., Romano, L., Castriconi, M., De Palma, M., & Noschese, G. (2019). Non-Operative Management of Blunt Liver Trauma: Safety, Efficacy and Complications of a Standardized Treatment Protocol. Bulletin of emergency and trauma, 7(1), 49-54. https://doi.org/10.29252/beat-070107
Brillantino, Antonio, et al. "Non-Operative Management of Blunt Liver Trauma: Safety, Efficacy and Complications of a Standardized Treatment Protocol." Bulletin of emergency and trauma vol. 7,1 (2019): 49-54. doi: https://doi.org/10.29252/beat-070107
Brillantino A, Iacobellis F, Festa P, Mottola A, Acampora C, Corvino F, Del Giudice S, Lanza M, Armellino M, Niola R, Romano L, Castriconi M, De Palma M, Noschese G. Non-Operative Management of Blunt Liver Trauma: Safety, Efficacy and Complications of a Standardized Treatment Protocol. Bull Emerg Trauma. 2019 Jan;7(1):49-54. doi: 10.29252/beat-070107. PMID: 30719466; PMCID: PMC6360015.
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Bull Emerg Trauma. 2019 Jan;7(1):49-54. doi: 10.29252/beat-070107.

Non-Operative Management of Blunt Liver Trauma: Safety, Efficacy and Complications of a Standardized Treatment Protocol.

Bulletin of emergency and trauma

Antonio Brillantino, Francesca Iacobellis, Patrizio Festa, Arianna Mottola, Ciro Acampora, Fabio Corvino, Santolo Del Giudice, Michele Lanza, Mariano Armellino, Raffaella Niola, Luigia Romano, Maurizio Castriconi, Maurizio De Palma, Giuseppe Noschese

Affiliations

  1. Department of Surgery, A. Cardarelli Hospital, Via A. Cardarelli 9 80131 Naples, Italy.
  2. Antonio Brillantino and Francesca Iacobellis are equally contributors.
  3. Department of Radiology, A. Cardarelli Hospital, Via A. Cardarelli 9 80131 Naples, Italy.
  4. Interventional Radiology Department, A Cardarelli Hospital, Via A. Cardarelli 9 80131 Naples, Italy.

PMID: 30719466 PMCID: PMC6360015 DOI: 10.29252/beat-070107

Abstract

OBJECTIVE: To evaluate the safety and effectiveness of NOM (non-operative management) in the treatment of blunt liver trauma, following a standardized treatment protocol.

METHODS: All the hemodynamically stable patients with computed tomography (CT) diagnosis of blunt liver trauma underwent NOM. It included strict clinical and laboratory observation, 48-72h contrast enhanced ultrasonography (CEUS) or CT follow-up, a primary angioembolization in case of admission CT evidence of vascular injuries and a secondary angioembolization in presence of vascular injuries signs at follow-up CEUS.

RESULTS: 181 patients (85.4%) [55 (30.4%) women and 126 (69.6%) men, median age 39 (range 14-71)] were included. Of these, 63 patients (34.8%) had grade I, 48 patients (26.5%) grade II, 39 patients (21.5%) grade III, 21 patients (11.6%) grade IV and 10 patients (5.5%) grade V liver injuries. The overall success rate of NOM was 96.7% (175/181). There was not significant difference in the success rate between the patients with different liver injuries grade. Morbidity rate was 7.4% (13/175). Major complications (2 bilomas, 1 liver hematoma and 2 liver abscesses) were successfully treated by CEUS or CT guided drainage. Eighteen (18/181) patients (9.9%) underwent angioembolization with successful results.

CONCLUSION: Non-operative management of blunt liver trauma represents a safe and effective treatment for both minor and severe injuries, achieving an high success rate and an acceptable morbidity rate. The angiographic study with embolization, although required only in selected cases of vascular injuries, represents a fundamental therapeutic option in a significant percentage of patients.

Keywords: Angioembolization; Blunt trauma; Hepatic trauma; Liver injury; Non-operative management

Conflict of interest statement

None declared.

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