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Nonoperative management of blunt liver injury in hemodynamically stable versus unstable patients: a retrospective study

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Abstract

Purpose

The success rate of nonoperative management (NOM) of traumatic liver injury is approximately 90%. Although NOM has become the standard treatment when patients’ vital signs are stable, open surgical hemostasis is often selected when these signs are unstable. At our hospital, we extensively use NOM along with transcatheter arterial embolization (TAE) to treat patients with severe abdominal trauma, as per our original protocol. We also apply NOM for severe liver injury with unstable hemodynamics. This retrospective study aimed to investigate the efficacy of NOM for blunt liver injury in hemodynamically stable and unstable patients.

Methods

We retrospectively examined 23 patients with severe liver injuries who underwent NOM after visiting our emergency outpatient department between 2007 and 2017. Patients were assigned to either the stable group with stable hemodynamics or the unstable group with unstable hemodynamics.

Results

The stable group comprised 13 patients, and the unstable group comprised 10 patients. All patients underwent TAE. While all patients in the stable group were discharged alive, one patient in the unstable group died during the hospital stay. The response rate to NOM was 90%, and no patient switched from NOM to open surgery. A higher rate of complications with a significantly longer average stay in the intensive care unit was observed in the unstable group.

Conclusions

Even in the unstable group, NOM with TAE performed under careful general management facilitated avoidance of open surgery and provided high survival rates.

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Abbreviations

NOM:

nonoperative management

OM:

operative management

TAE:

transcatheter arterial embolization

ACS:

abdominal compartment syndrome

ICU:

intensive care unit

ER:

emergency room

OIS:

Organ Injury Scale

sBP:

systolic blood pressure

ISS:

injury severity score

Ps:

probability of survival

CT:

computed tomography

IVR:

interventional radiology

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Authors and Affiliations

  1. Department of Surgery, Kariya Toyota General Hospital, 5-15 Sumiyoshi-cho, Kariya, Aichi, 448-8505, Japan

    Koichi Inukai & Shuhei Uehara

  2. Department of Radiology, Kariya Toyota General Hospital, 5-15, Sumiyoshi-cho, Kariya, Aichi, 448-8505, Japan

    Yoshiteru Furuta

  3. Department of Emergency and Intensive Care, Kariya Toyota General Hospital, 5-15 Sumiyoshi-cho, Kariya, Aichi, 448-8505, Japan

    Masanao Miura

Authors
  1. Koichi Inukai
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  2. Shuhei Uehara
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  3. Yoshiteru Furuta
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  4. Masanao Miura
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Corresponding author

Correspondence to Koichi Inukai.

Ethics declarations

Ethical approval was obtained from IRB of our hospital. For this type of study, formal consent is not required.

Conflict of interest

The authors declare that they have no conflict of interest.

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Inukai, K., Uehara, S., Furuta, Y. et al. Nonoperative management of blunt liver injury in hemodynamically stable versus unstable patients: a retrospective study. Emerg Radiol 25, 647–652 (2018). https://doi.org/10.1007/s10140-018-1627-6

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  • DOI: https://doi.org/10.1007/s10140-018-1627-6

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