Non operative management of grade IV (AAST) (WSES III) liver injury due to blunt thoracoabdominal trauma

Abstract text (incl. references and figure legends)

Case history

25 year old female brought to the Emergency Department presenting blunt thoracoabdominal trauma following a horse-riding accident

Clinical findings

BP: 126/93 mmHg, HR: 105 bpm PE: laceration with hematoma at right costal cage. Normal abdominal exploration

Results and diagnosis

Laboratory tests: hypertransaminasemia with normal blood count and coagulation profile CT Scan: fifth and sixth displaced right costal fractures causing a 10 cm right hepatic intraparenchymal hematoma (figure 1). No active bleeding was demonstrated.

Therapy and progressions

Admission to Intensive Care Unit remaining HD stable, without requiring blood transfusions Day 10 control CT Scan: improvement of liver injuries. No associated complications Ten-month follow-up: asymptomatic with no radiologic complications

Comments

NOM is considered the standard of care both in blunt and penetrating liver injuries given two absolute requirements: HD stability and absence of other lesions requiring surgery We present a blunt thoracoabdominal trauma causing a major penetrating liver injury (AAST IV–WSES III) due to displaced costal fractures piercing the right hepatic lobe (figure 2) The ability to diagnose all associated injuries and to provide intensive management are paramount for the application of NOM Management of liver trauma is multidisciplinary and, when feasible, NOM should always be considered as a first option

References

1. Taghavi S, Askari R. Liver Trauma. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2022 Jan/2. Coccolini F, et al. Liver trauma: WSES 2020 guidelines. World J Emerg Surg. 2020 Mar 30;15(1):24/3. Cimbanassi S, et al. Nonoperative management of abdominal solid-organ injuries following blunt trauma in adults: results from an International Consensus Conference. J Trauma Acute Care Surg. 2018;84(3):517–531/4. Biffl WL, Leppaniemi A. Management guidelines for penetrating abdominal trauma. World J Surg. 2015;39(6):1373–1380

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