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LIVER CONTUSIONS: INDICATIONS FOR NON OPERATIVE APPROACH

Keywords: LIVER TRAUMA , NON-OPERATIVE APPROACH , LAPAROTOMY

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Abstract:

The most important condition for a conservative treatment of the liver trauma is a stable patient. Ultrasound and computerized tomography (CT) examinations are essential for the investigation of abdominal trauma. These explorations allow visualization of solid organ anatomy and have the ability to grade and quantify the livers' injuries (Mirvis classification). After the first exploration and the decision for initial non-operative approach, the patients will be followed in the intensive care unit (hemodynamic status, biological exploration, CT or ultrasonography). In this second survey period it is possible to appear complications (hemorrhage, peritonitis, intra-abdominal hyper-pressure syndrome etc.) and emergency laparotomy can be necessary. The overall mortality for non operative approach is about 9%, and direct mortality is under 1%. Secondary operations are necessary in 7-10% from these patients. Interventional radiology techniques and endoscopic procedures (such as endoscopic retrograde cholangio-pancreatography) allowed the reduction of the secondary surgical interventions. Hospital stay depends by the grade of the liver injury. Long term follow-up it is necessary; some cystic image can appear in the liver parenchyma at CT exam after months or years from the trauma, but without clinical significance.

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