Non-Operative Management of Adult Blunt
Hepatic Trauma Algorithm

Historic perspective

During the past 2 decades, treatment of blunt hepatic injuries has dramatically changed. A shift occurred from operative management emphasizing nonresectional techniques and packing in the 1980s to selective nonoperative management in the 1990s and now to nonoperative management with selective operative management. Decreased mortality associated with nonoperative management can be credited to astute observations made by trauma surgeons in concert with the use of computed tomography (CT) to aid in the diagnosis of hepatic injuries, availability of angioembolization for treatment of bleeding hepatic injuries, and appreciation of the coagulopathy of trauma.3–6 Table 1 summarizes the success of nonoperative management and its associated low hepatic-related morbidity and mortality.7–11 Only studies with more than 50 adult patients with blunt hepatic trauma treated by nonoperative management were included. A recent review of the National Trauma Data Base noted that 86.3% of hepatic injuries are now managed without operative intervention,12 an even higher percentage than previous studies reported.7,9 Not surprisingly, more complications related to nonoperative management are being diagnosed. The following algorithm focuses on nonoperative management of blunt hepatic trauma.