Nonoperative management of blunt splenic and liver injuries in adult polytrauma

Background: Isolated splenic or hepatic injuries are present in approximately 30% of all cases of adult abdominal trauma. Most authors quoted above have limited nonoperative management (NOM) to patients with isolated organ injury. Results of NOM following blunt hepatic and splenic trauma in patients with multiple injuries were evaluated in this study.
Materials and Methods: Retrospective chart review was performed on multiple injured adults with splenic and liver injures resulting from blunt trauma. Associated injuries, clinical signs at presentation, used diagnostic tools, injury grading, transfusion requirements, morbidity and mortality were documented.
Results: Medical records of 275 patients aged from 17 to 81 years with blunt splenic and liver trauma and associated injuries were analyzed. Patients with hemodynamic instability or obvious peritoneal signs were excluded from further study. Surgery was indicated in 106 patients without response or transient response for fluid challenge. 131 of 237(55%) patients were selected for NOM: 78 with splenic, 46 with liver and 7 with injuries to both. 25(19%) patients were older 55 years. The mean injury severity score was 25.2. Injury grade ranged from I-IV and the degree of hemoperitoneum was from mild to severe. 8 patients failed NOM (6%). Mean blood transfusion requirement during first 24 hours at admission was 0.3 units. Morbidity rate was 1.2%. Two patients (1.5%) died following severe head trauma.
Conclusion: Nonoperative strategy is the preferred modality for the care of blunt splenic and liver injuries in the hemodynamically stable patients, irrespective of age, grade of injury, associated injuries or degree of hemoperitoneum.

Keywords
Blunt abdominal trauma, nonoperative management, spleen and liver injury