Non-operative management of severe liver injuries after blunt abdominal trauma – experiences from university medical center Ljubljana

Abstract text (incl. references and figure legends)

Introduction: The liver is one of the most commonly injured parenchymal organs during blunt abdominal trauma. Sever liver injury is associated with significant morbidity and mortality. Hemodinamically stabile patients are now successfully treated with non-operative management (NOM). We present a case series of patients with sever liver injury due to blunt abdominal trauma that were successfully treated with NOM. Materials and methods: A single-center retrospective case series of nine patients (7 males, 2 females; median age 40 ± 25.1 years, range 9 – 83 years) after blunt abdominal trauma resulting in sever liver injury (AAST score 4 and 5) who were treated with NOM at the University Medical Center Ljubljana from April 2017 to July 2020 was performed. The evaluation of imaging, interventional and/or endoscopic interventions, complication rates and the length of hospital stay were recorded and evaluated. Results: Traffic accidents were the main cause of blunt abdominal trauma representing 44.5% of sever liver trauma, followed by the fall from the height (22.2%) and animal related injuries (22.2%). One case of unknown mechanism in a patient under influence of alcohol was recorded (11.1%). Concomitant injuries requiring surgical intervention were recorded in one patient. At the initial CT scan an active bleeding requiring embolization was present in three patients. Late complications requiring interventional and/or endoscopic interventions were noted in 55.5% (5/9 patients). The mean hospital stay was 38.4 ± 26.7 days (range 10 – 90 days). No morbidity was noted. Conclusions: Liver is one of the most commonly injured organs in the abdominal cavity. The management is complex and requires a multidisciplinary approach. Liver injuries, even severe ones, can be successfully treated with NOM.

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