Conservative approach in the management of isolated penetrating liver trauma

Background: Damage to the liver is the most common cause of death after abdominal injury. The most common cause of liver injury is blunt abdominal trauma. In the case of penetrating injury, non-intervention management has not been adequately addressed. Selective non-operative management of stab wounds especially to the liver has been reported. Methods: This study was carried out from May 2006 to April 2011 at the Main Alexandria University Hospital, Faculty of Medicine, Alexandria, Egypt. This study consisted of 62 liver trauma patients and the following data were collected: demographics, mechanism of injury, pre-hospital care, hemodynamic status, grade of hepatic injury, associated injuries, failure of non-operative (NOP) management, hospital stay in intensive care unit (ICU) or in the ward and death. Patients were eligible for the study if they sustained isolated penetrating right hypochondrial injury. Assessment of hemodynamic stability was based on routine vital signs. Injury severity was determined from CT and classified by means of the Liver Injury Scale. Results: This study was carried out for 62 consecutive patients with hepatic trauma in a five year period. Mean age was 33.6 years with a range of 16–54 years. The isolated penetrating liver injuries included knives, guns (gunshot shotgun injuries) and other sharp objects. All patients were treated successfully via NOP management except five patients (8%) who failed NOP management. These five patients were hemodynamically unstable and were unresponsive to crystalloid and blood transfusion. The five patients underwent surgery (suturing, packing, and resectional debridement). Two patients (3.2%) died because of high grade liver injury. The overall actuarial one-year survival in NOP management was 96.8%. Conclusions: Low grade penetrating hepatic injuries (G I-III) can be managed non-operatively with excellent results; even G IV penetrating liver injuries with hemodynamically stable patients can be managed safely non-operatively.