Non-Operative Management of Adult Blunt
Hepatic Trauma Algorithm
Annotation for Point K
Not surprisingly, because more aggressive nonoperative management is being pursued, more liver-related complications are being diagnosed. Although routine follow-up CT scans are not necessary, persistent systemic inflammatory response syndrome, abdominal pain, jaundice, or an unexplained drop in hemoglobin should prompt an evaluation by CT scanning.39 Complications are primarily related to the grade of liver injury and the need for transfusion.36 Reported complication rates range from 0% to 7% when all grades are considered, but can be as high as 14% when only high-grade injuries are considered. Paramount to the successful management of hepatic complications is a multimodality treatment strategy to include endoscopic retrograde cholangiographic embolization (ERCP) and stenting, transhepatic angioembolization, and image guided percutaneous drainage techniques. Despite these advances, operative intervention still plays a role. When patients not requiring laparotomy within the first 24 hours after injury were examined, complications that required delayed operative intervention included bleeding, abdominal compartment syndrome, and failure of percutaneous drainage techniques.36 Delayed hemorrhage is the most frequent, although still rare, postinjury complication.9,36,38 “Late” bleeds from blunt hepatic injuries generally occur within the first 72 hours postinjury.36 Management principles discussed earlier should be applied and may include angioembolization or operative stabilization.