NONOPERATIVE MANAGEMENT OF BLUNT HEPATIC AND SPLENIC INJURIES: A PROSPECTIVE STUDY

Aim: Nonoperative management (NOM) of blunt hepatic and splenic trauma in hemodynamically stable patients has become the treatment of choice in most trauma centers. The aim of this prospective study was to define the safety and success rate of NOM of blunt hepatic and splenic trauma within the setting of our Alexandria Main University Hospital. Methods: Nonoperative management criteria included hemodynamic stability and absence of other injuries requiring laparotomy. Patients were closely observed in the surgical ward unless ICU admission was indicated for an associated injury. Results: Forty two consecutive patients with injury to the liver (n=16) and lor spleen (n=33) were included. Associated injuries were present in 34 patients (82%). Ten patients (23.8%) underwent immediate laparotomy. Of the remaining 32 patients, 2 (6.2%) failed NOM with no complications related to the delayed laparotomy. The remaining 30 patients were successfully treated nonoperatively with ICU admission required in only 2 patients. The 30 patients had 35 liver and/or splenic injuries; 2 were grade I, 13 were grade II, 13 were grade III, and 7 were grade IV. Conclusion: The majority of patients with blunt liver and spleen injuries (71.4%) can be successfully and safely managed without laparotomy