Non-Operative Management of Isolated Blunt Hepatic Trauma - An Observational Study

Author(s): Waseem Ahmad Dar1 , Shaukat Jeelani2 , Umer Mushtaq3 , Asgar Aziz Baba4 , Farzanah Nowreen5 , Irshad Ahmad6

BACKGROUND Blunt trauma is one of the most serious and most common causes of death in youth. Specifically, liver is one of the most frequently injured organs during abdominal trauma. During the last two decades, management of blunt trauma to the liver has changed from mainly operative intervention, to the current practice of selective operative and non-operative management (NOM). Avoidance of a laparotomy with its short- and long-term risks is of great benefit to the patient. Majority of patients admitted for liver injury have grade I, II and III injuries and are successfully treated with non-operative management. METHODS We conducted a prospective observational study over a period of 24 months between August 2017 and August 2019 among a total of 48 patients, in the Department of General Surgery, Government Medical College, Srinagar, and associated hospitals who were haemodynamically stable with isolated blunt hepatic trauma. RESULTS As liver trauma occurs more frequently in men, we found that male to female ratio was 3 : 1. In our study, 97 % of patients with isolated blunt hepatic trauma were haemodynamically stable, rest 3 % patients stabilized after initial resuscitation. Most of the complications 14.58 % occurred in higher grade injuries (grade IV and V). The complication rate in our study group was 18.75 %. CONCLUSIONS About 90 % of haemodynamically stable patients with isolated blunt hepatic injury can be managed successfully by non-operative management and nonoperative management is the treatment of choice irrespective of the grade of injury, mode of blunt trauma, age, and gender.