Interventional techniques are useful adjuncts in nonoperative management of hepatic injuries

Background: Nonoperative management has become the standard of care for hem odynamically stable patients with complex liver trauma. The benefits of suc h treatment may be obviated, though, by complications such as arteriovenous fistulas, bile leaks, intrahepatic or perihepatic abscesses, and abnormal communications between the vascular system and the biliary tree (hemobilia and bilhemia), Methods: We reviewed the hospital charts of 135 patients with blunt liver t rauma who were treated nonoperatively between July 1995 and December 1997, Results: Thirty-two patients (24%) developed complications that required ad ditional interventional treatment. Procedures less invasive than celiotomy were often performed, including arteriography and selective embolization in 12 patients (37%), computed tomography-guided drainage of infected collect ions in 10 patients (31%), endoscopic retrograde cholangiopancreatography w ith endoscopic sphincterotomy and biliary endostenting in 8 patients (25%), and laparoscopy in 2 patients (7%). Overall, nonoperative interventional p rocedures were used successfully to treat these complications in 27 patient s (85%), Conclusion: In hemodynamically stable patients,vith blunt liver trauma, non operative management is the current treatment of choice. In patients with s evere liver injuries, however, complications are common. Most untoward outc omes can be successfully managed nonoperatively using alternative therapeut ic options. Early use of these interventional procedures is advocated in th e initial management of the complications of severe blunt liver trauma.