Iranian Journal of Surgery

Outcomes of Conservative Management of Liver and Spleen Damages in the Blunt Traumas; Single Center Experience

Authors

Kh Ayazi 1
B Nematihonar 2
AD Bashirirad 3
H Zaferani Arani 4
A Haghbin Toutounchi 5

1 Associate Professor, Department of General Surgery, Shahid Beheshti University of Medical Sciences, Imam Hossein Hospital

2 Associate Professor of General Surgery & Laparoscopic Surgery, Shahid Beheshti University of Medical Sciences and Health Services, Imam Hossain Hospital, Tehran, Iran

3 General Surgeon, Shahid Beheshti University of Medical Sciences, Imam Hossein Hospital

4 Department of General Surgery, Tehran University of Medical Sciences

5 General Physician, Shahid Beheshti University of Medical Sciences, Imam Hossein Hospital

Abstract
Introduction & Objective: Evidence is accumulating on the efficacy of non-operative management of blunt hepatic and splenic trauma as the treatment of choice in these patients. Materials & Methods: In this prospective study, our sample comprised of patients referred to the emergency department of Imam Hosein Hospital with blunt hepatic and splenic trauma confirmed by CT-scan and ultrasound. All of the hemodynamically stable patients, with no other indications for laparotomy were monitored in the ICU and managed non-operatively. The management plan changed accordingly in cases that non-operative plan failed. Results: In our subjects, 61(49.2%), 50(40.3%) and 13 (10.5%) had hepatic, splenic and concomitant blunt hepatic and splenic trauma, respectively. Non-operative management succeeded in 103 (83%); in the remaining 21 (17%) patients, older age and higher trauma grades were significantly associated with the failure of non-operative management. Concomitant trauma, particularly head trauma was only significantly associated with the failure of non-operative management in those with blunt splenic trauma. Conclusions: Non-operative management of the blunt hepatic and splenic trauma in hemodynamically stable patients is considered the treatment of choice, with high efficacy and low complications if managed successfully. Yet, due to considerable complications associated with the failure of non-operative treatment, independent prognostic factors that could predict unsuccessful management should be considered in advance by the surgical team. Important predictors of failure are older age, particularly above 55, concomitant trauma, especially to the head and higher grades of trauma.

Keywords

Blunt Hepatic Trauma
Blunt Splenic Trauma
Non-Operative Management
Conservative Management
1. Hemmati H, Kazemnezhad-Leili E,
Mohtasham-Amiri Z, Darzi AA, Davoudi-Kiakalayeh A, Dehnadi-Moghaddam A, Kouchakinejad Eramsadati L. Evaluation of chest and abdominal injuries in trauma patients hospitalized in the surgery ward of poursina teaching hospital, guilan, iran. Archives of trauma research. 2013; 1(4): 161.
2. Motie MR, Behnampour N, Alinezhad H. Epidemiology of blunt abdominal trauma in
Gorgan-Iran (2001-05). Journal of Gorgan University of Medical Sciences. 2009; 10(4): 55-86.
3. Abri B, Vahdati SS, Paknezhad S, Alizadeh S. Blunt abdominal trauma and organ damage and its prognosis. Journal of Research in Clinical Medicine. 2016 Dec 24; 4(4): 228-32.
4. Hashemzadeh SH, Hashemzadeh KH, Dehdilani M, Rezaei S. Non-operative management of blunt trauma in abdominal solid organ injuries: a prospective study to evaluate the success rate and predictive factors of failure. Minerva chirurgica. 2010 Jun 1; 65(3):
267-74.
5. Notash AY, Amoli HA, Nikandish A, Kenari AY, Jahangiri F, Khashayar P. Non-operative management in blunt splenic trauma. Emergency Medicine Journal. 2008 Apr 1; 25(4): 210-2.
6. Zargar M, Laal M. Liver trauma: operative and Nonoperative management. International Journals of Collaborative Research on Internal Medicine & Public Health. 2010 Apr 1; 2(4): 96-107.
7. Ibrahim W, Mousa G, Hirshon JM, El-Shinawi M, Mowafi H. Non-operative management of blunt abdominal solid organ trauma in adult patients. African Journal of Emergency Medicine. 2020 Sep 1; 10(3): 123-6.
8. Brillantino A, Iacobellis F, Festa P, Mottola A, Acampora C, Corvino F, Del Giudice S, Lanza M, Armellino M, Niola R, Romano L. Non-operative management of blunt liver trauma: safety, efficacy and complications of a standardized treatment protocol. Bulletin of Emergency & Trauma. 2019 Jan; 7(1): 49.
9. Norrman G, Tingstedt B, Ekelund M, Andersson R. Non-operative management of blunt liver trauma: feasible and safe also in centres with a low trauma incidence. Hpb. 2009 Feb 1; 11(1): 50-6.
10.    Kanlerd A, Auksornchart K, Boonyasatid P.
Non-operative management for abdominal solidorgan injuries: A literature review. Chinese Journal of Traumatology. 2022 Sep 1; 25(05): 249-56.
11.    Fodor M, Primavesi F, Morell-Hofert D, Kranebitter V, Palaver A, Braunwarth E,
Haselbacher M, Nitsche U, Schmid S,
Blauth M, Gassner E. Non-operative
management of blunt hepatic and splenic injury: a
time-trend and outcome analysis over a period
of 17 years. World Journal of Emergency Surgery. 2019 Dec; 14: 1-2.
12.    Presser E, Sznol JA, Schuster KM. Management and Outcome of High-Grade Hepatic and Splenic Injuries. Current Surgery Reports. 2023 Mar; 11(3): 55-63.
13.    Yıldız A, Özpek A, Topçu A, Yücel M, Ezberci F. Blunt splenic trauma: Analysis of predictors and risk factors affecting the non-operative management failure rate. Turkish Journal of Trauma & Emergency Surgery. 2022 Oct; 28(10): 1428.
14.    Rizk AG, Abo Halawa NA, Abdelrasheed AA, Arteen AR. Non-operative management of blunt liver trauma in Qena University Hospital.
SVU-International Journal of Medical Sciences. 2023 Jan 1; 6(1): 406-11.
15.    Chalya PL, Mabula JB, Giiti G, Chandika AB, Dass RM, Mchembe MD, Gilyoma JM. Splenic injuries at Bugando Medical Centre in northwestern Tanzania: a tertiary hospital experience. BMC Research notes. 2012 Dec; 5: 1-9.
16.    Ohanaka EC, Osime U, Okonkwo CE. A five year review of splenic injuries in the University of Benin Teaching Hospital, Benin City, Nigeria. West African journal of medicine. 2001 Jan 1; 20(1): 48-51.
17.    Osifo OD, Enemudo RE, Ovueni ME. Splenic injuries in children: The challenges of non operative management in a developing country. Journal of Indian Association of Pediatric Surgeons. 2007 Oct 1; 12(4): 209.
18.    Tan KK, Chiu MT, Vijayan A. Management of isolated splenic injuries after blunt trauma: an institution’s experience over 6 years. Med J Malaysia. 2010 Dec 1; 65(4): 306-8.
19.    Saavedra MZ, Alonso AJ, Cabrera BP, García AM, García VM, Pozo BM, Petrone P. Management of Splenic Injuries Utilizing a multidisciplinary protocol in 110 consecutive patients at a level II hospital. Cirugía Española (English Edition). 2020 Mar 1; 98(3): 143-8.
20.    Cirocchi R, Boselli C, Corsi A, Farinella E, Listorti C, Trastulli S, Renzi C, Desiderio J, Santoro A, Cagini L, Parisi A. Is non-operative management safe and effective for all splenic blunt trauma? A systematic review. Critical Care. 2013 Oct; 17(5):
1-8.
21.    Bhangu A, Nepogodiev D, Lal N, Bowley DM. Meta-analysis of predictive factors and outcomes for failure of non-operative management of blunt splenic trauma. Injury. 2012 Sep 1; 43(9): 1337-46.
22.    Bala M, Edden Y, Mintz Y, Kisselgoff D, Gercenstein I, Rivkind AI, Farugy M, Almogy G. Blunt splenic trauma: predictors for successful
non-operative management. The Israel Medical Association journal. 2007 Dec 1; 9(12): 857.
23.    Swaid F, Peleg K, Alfici R, Matter I, Olsha O, Ashkenazi I, Givon A, Kessel B, Israel Trauma Group. Concomitant hollow viscus injuries in patients with blunt hepatic and splenic injuries: an analysis of a National Trauma Registry database. Injury.
2014 Sep 1; 45(9): 1409-12.
24.    Velmahos GC, Zacharias N, Emhoff TA, Feeney JM, Hurst JM, Crookes BA, Harrington DT, Gregg SC, Brotman S, Burke PA, Davis KA. Management of the most severely injured spleen: a multicenter study of the Research Consortium of New England Centers for Trauma (ReCONECT). Archives of Surgery. 2010 May 1; 145(5): 456-60.
25.    Javed S, Shahid MH, Naqvi SW, Khan AZ, Javed A, Kaiser A, Aslam S. Blunt Liver Trauma: Spectrum of injuries and outcomes, managed At Level–I Trauma Center.
26.    Saviano A, Ojetti V, Zanza C, Franceschi F, Longhitano Y, Martuscelli E, Maiese A,
Volonnino G, Bertozzi G, Ferrara M, La Russa R. Liver Trauma: Management in the Emergency
Setting and Medico-Legal Implications. Diagnostics. 2022 Jun 13; 12(6): 1456.
27.    Rajab KK, Shakir HN, Muhsin AM. Outcome of Blunt Liver Injuries in Al-Yarmook Teaching Hospital. Himalayan Journal of Medicine and Surgery. 2022 Jun 10; 3(3).
28.    Hashish S. Outcome and Efficacy of
Non-Operative Management (NOM) in Traumatic Liver Injuries. Ain Shams Journal of Surgery. 2023 Jan 1; 16(1): 1-8.
29.    Pegna V, Askari A, Chong S, Bull A,
Kennedy L, Jaunoo S, Khan M. Intervention
for Splenic Trauma: An International
Consensus Survey. Panamerican Journal of Trauma, Critical Care & Emergency Surgery. 2023 Apr 29; 12(1): 9-15.
30.    Shahab H, Khalid OB, Jawaid B, Salman S, Erum U, Faheem K. Outcomes of Conservative Management in a Clinically Stable Patient with Traumatic Liver Injury. Pakistan Journal of Medical & Health Sciences. 2023 Mar 10; 17(01): 659.
Iranian Journal of Surgery
Volume 31, Winter
Winter 2024
Pages 25-34

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