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VOLUME 7 , ISSUE 1 ( January-April, 2018 ) > List of Articles

ORIGINAL ARTICLE

Nonoperative Management in Blunt Liver Trauma: A Study done in a Tertiary Care Hospital of a Hilly State in India

Arun K Gupta, Vijay S Chandel, Lata R Chandel, Arun Chauhan, Parikshit Malhotra

Keywords : Blunt trauma, Nonoperative management, Prospective study, Road traffic accident

Citation Information : Gupta AK, Chandel VS, Chandel LR, Chauhan A, Malhotra P. Nonoperative Management in Blunt Liver Trauma: A Study done in a Tertiary Care Hospital of a Hilly State in India. Panam J Trauma Crit Care Emerg Surg 2018; 7 (1):33-37.

DOI: 10.5005/jp-journals-10030-1201

License: CC BY-NC 4.0

Published Online: 01-01-2017

Copyright Statement:  Copyright © 2018; The Author(s).


Abstract

Aim: To evaluate the efficacy of nonoperative treatment in blunt trauma liver. Materials and methods: A 1-year prospective study was conducted in the Department of Surgery, Indira Gandhi Medical College (IGMC), Shimla, Himachal Pradesh, India, on 31 patients with blunt trauma with liver injuries proved on ultrasonography (USG) focused assessment with sonography for trauma (FAST) and contrast-enhanced computed tomography (CECT) abdomen. Once admitted, patients with grades I or II liver injury with no other comorbidities and other associated injuries were managed conservatively. Patients with grades III, IV, or V liver injury or lower grade liver injury with other associated injuries were observed and monitored strictly. Patients were considered a failure if the patient developed signs of peritonitis. Results: Out of 83 patients with blunt abdominal trauma, 31 patients fulfilled the inclusion criteria for nonoperative management (NOM). The incidence of blunt liver trauma (BLT) was 37.34% Out of these, one patient required operative management (OM). Average age was 27 years. Out of 31 patients, 25 (80.6%) patients were males and 6 (19.4%) were females. Totally, 24 (77.4%) patients acquired injury due to road side accidents. Totally, 25 (80.6%) patients reported to the hospital within 6 hours of injury and 5 (16.1%) within 7 to 12 hours. On grading of liver injuries depending on CECT findings, 6 (19.4%) patients presented with grade I injury, 7 (22.6%) patients with grade II injury, 11 (35.5%) with grade III injury, and 6 (19.4%) with grade IV injury. Grade V injury was noted in 1 (3.2%) patient. Sixteen patients required blood transfusion. The NOM was successful in 96.8% of the patients. Liver-specific success rate of NOM was 100%. Mean hospital stay was 10.8 days for NOM. Conclusion: Patients of blunt liver injury who are hemodynamically stable should be considered for NOM. Clinical significance: The NOM is a highly feasible and safe method for being cost-effective, requiring shorter hospital stay, and avoiding high morbidity.

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