Non-Operative Management of Adult Blunt
Hepatic Trauma Algorithm
Annotation for Point H
Neither the presence nor the absence of active bleeding on CT scanning absolutely predicts the need for angiography. Vasospasm at the time of CT and delayed clot lysis can both contribute to an initial lack of contrast extravasation, whereas active bleeding may be due to hemorrhage from portal or hepatic vein lesions. Bleeding seen during the arterial phase of the scan, however, confirms bleeding from an arterial source. Angioembolization is an important adjunct to management of patients managed both operatively and nonoperatively with high-grade liver injuries. Early angioembolization can decrease the need for transfusions and liver-related operations.29,30 Conflicting data exist as to whether it can improve outcome in patients requiring operative intervention.20,31,32 Unless angiography is immediately available, most would consider preoperative angiography only for stable patients with pooling seen on CT scanning. There are several reports, however, suggesting that angiography be used as an extension of resuscitation in patients with ongoing resuscitative needs.33,34 This practice cannot be advocated except in selected centers.