An Analytical study on Nonoperative Management of Liver Injury in Blunt Trauma to the Abdomen: A Prospective study

INTRODUCTION: The trend from operative management has shifted towards conservative management in liver injuries. The present study was done to evaluate the efficacy of conservative management in patients with blunt trauma to abdomen with liver injury, to form a guideline to help decide when to abandon conservative line of treatment and opt for surgical intervention and to study the complications arising due to conservative management of blunt injury liver. AIMS AND OBJECTIVES: 1. To evaluate the efficacy of conservative management in patients with blunt trauma to abdomen with liver injury. 2. To form a guideline to help decide when to abandon conservative line of treatment and opt for surgical intervention. 3. To study the complications arising due to conservative management of blunt injury liver. METHODS: From July 2017 to June 2019, a prospective Single Center Study was done in patients admitted to department of surgery GMKMCH, who were diagnosed to have blunt injury abdomen. Data was collected with regards to age, demographic characteristics, socio economic status, detailed history and type of injuries including patient’s complaints and duration of complaints. A detailed general examination was done and hemodynamic stability was ensured. The results were analyzed statistically using IBM SPSS v 23.0 RESULTS: The mean age of the patients was 35.80 years, out of 50 patients, the males were in majority (n=44, 88%). Majority of the cases were due to road traffic accidents (62%, n=31). The mean latent period is 2.7 hours, mean pulse rate reduced from 95.64/ minute on day of admission to 77.64/minute on 7th day. The mean haemoglobin reduced from 95.64/ minute on day of admission to 77.64/minute on 7th day. The liver function tests shows that on the day of admission, the liver function tests were within normal limits for all patients. On 3rd day, the liver parameters were elevated for 10% (n=5) of the patients. On 7th day, the liver parameters were elevated for 20% (n=10) of the patients. The patients presented with mild hemoperitoneum in 60% (n=30) of the cases. The grading of liver injury shows that majority of them were in Grade I (n=17, 34%). Grade II (n=13, 26%), Grade III (n=12, 24%) and Grade IV (n=8, 16%). Out of 50 patients, 48 (96%) of them were managed conservatively while two of them (4%) were chosen for emergency laparotomy. Out of 48 patients in conservative group, three of them died while in the emergency laparotomy group, one of them died. CONCLUSION: Grading of hepatic injury severity does not correlate with the management practices. This brings in the necessity of grading patients based on their hemodynamic status. One of the positive aspects of this nonoperative management is the impact on isolated liver trauma, optimisation of resources and it is highly economical