Nonoperative Management of Hepatic Injury

Nonoperative management of hepatic injury has become the norm. Several recent large series have documented successful nonoperative treatment in 90 percent of patients who are hemodynamically stable at presentation.18 Liver injuries are most commonly classified according to the system described by the American Association for the Surgery of Trauma (AAST) (Table.252:3). Unfortunately, most patients in these large series have had relatively low-grade injuries. Complications of nonoperative management of hepatic injuries include delayed bleeding, bile leak, intraabdominal sepsis, and missed intraabdominal injuries. These are relatively rare and occurred in only 5 percent of the largest series of nonoperative management of liver injuries. 18 However, the vast majority of complications occurred in higher-grade injuries.

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