Non-Operative Management of Adult Blunt
Hepatic Trauma Algorithm

Annotation for Point J

Operative intervention is still required for the patients sustaining blunt hepatic trauma, primarily related to hemodynamic instability on presentation. Christmas et al.37 confirmed higher liver-related morbidity and mortality for the patients undergoing operative intervention. When surgery is indicated, management should focus on cessation of bleeding, applying the principles of damage control surgery and hemostatic resuscitation.38 Different from operative intervention for blunt splenic injuries, bleeding from blunt hepatic injuries may actually be exacerbated by operation. In fact, Richardson et al.3 suggested that the primary reason for the decrease in hepatic-related mortality over the past several decades is the shift to nonoperative management. A detailed description of operative management is beyond the scope of this text but will be a future topic for critical decisions.