Computed tomography, angiography, and endoscopic retrograde cholangiopancreatography in the nonoperative management of hepatic and splenic trauma

There is a marked trend toward nonoperative management of abdominal trauma. This has been possible thanks to the advances in imaging and interventiona l techniques. In this work we review in which way computed tomography (CT) abdominal scans, angiography, and endoscopic retrograde cholangiopancreatog raphy (ERCP) can guide the nonoperative management of hepatic and splenic t rauma. The CT abdominal scan with intravenous contrast is the "departure im aging" of choice for the nonoperative management of hepatic and splenic tra uma in the hemodynamically stable patient. It is the most accurate test for detecting, defining, and characterizing these injuries, the associated hem operitoneum, and other abdominal abnormalities (the hollow viscus injuries missed on the CT scan were detected by clinical parameters and had no negat ive consequences in the outcome). It has an accuracy of more than 95% for t hese injuries, but CT grading alone cannot decide which patient can be trea ted conservatively and which patient requires surgery. Its usefulness for f ollow-up seems challenging. Angiography can be therapeutic, thereby avoidin g surgery (some report that angiography can be performed even in patients w ith active bleeding as damage control); if vessel injury, active bleeding o r hemobilia are suspected on the basis of a CT scan in a stable patient, an giography should be carried out. ERCP should be performed in patients with suspected injury to the biliary tree, even with normal iminodiacetic acid r adionuclide scanning (HIDA) if symptoms persist. A biliary stent can be pla ced. Indications for angiography and ERCP remain unclear.