Published: 2019-05-28

Study of outcomes in patients with conserved blunt liver and splenic injuries

Prashant Meshram


Background: Blunt abdominal injuries in the modern day are common due to vehicular accidents. Young males are more commonly involved and liver and spleen are the commonest organs injured. During the last century, the management of blunt force trauma has changed from observation and expectant management in the early part of the 1900s to operative intervention for all injuries, to the current practice of selective operative and nonoperative management.

Methods: We studied outcomes of conservatively managed liver and splenic injuries in 51 patients who presented to a tertiary referral center over a period of 1 year. Patient demographics and outcomes were studied.

Results: Males in the age group of 16-30 years were commonly involved. Liver was the commonest organ injured. Both liver and spleen were injured together only in 3 patients. One patient of liver injury was subjected to delayed surgery and 2 patients of splenic injury failed conservative management. Thus, the success rate of conservative management of blunt liver injuries was 96.87% and in splenic injuries was 90.91%.

Conclusions: Outcome of conservative management of blunt liver and splenic injuries is extremely good, especially in patients who maintained hemodynamic stability. Nonoperative management of blunt liver splenic injuries should be the treatment modality of choice in hemodynamically stable patients with any grades of injuries.


Blunt abdominal trauma, Conservative management, Hemodynamic stability, Liver injuries, Splenic injuries

Full Text:



Slotta JE, Justinger C, Kollmar O, Kollmar C, Schäfer T, Schilling MK. Liver injury following blunt abdominal trauma: a new mechanism-driven classification. Surg Today. 2014;44(2):241-6.

Stassen NA, Bhullar I, Cheng JD, Crandall ML, Friese RS, Guillamondegui OD, et al. Eastern Association for the Surgery of Trauma. Selective nonoperative management of blunt splenic injury: an Eastern Association for the Surgery of Trauma practice management guideline. J Trauma Acute Care Surg. 2012;73(5):294-300.

Pachter HL, Guth AA, Hofstetter SR, Spencer FC. Changing patterns in the management of splenic trauma. Ann Surg. 1998;227(5):708-19.

Champion HR, Sacco WJ, Copes WS, Gann DS, Gennarelli TA, Flanagan ME. A revision of the Trauma Score. J Trauma. 1989;29(5):623-9.

Baker SP, O'Neill B, Haddon W Jr, Long WB. The injury severity score: a method for describing patients with multiple injuries and evaluating emergency care. J Trauma. 1974;14(3):187-96.

Boyd CR, Tolson MA, Copes WS. Evaluating trauma care: the TRISS method. Trauma Score and the Injury Severity Score. J Trauma. 1987;27(4):370-8.

Patel J, Williams JS, Shmigel , Hinshaw JR. Preservation of splenic function by auto transplantation of traumatized spleen in man. Surgery. 1981;90(4):683-8.

Peter Mucha, Micheal B Farnell, Richard C Daly. Selective management of blunt splenic trauma. J Trauma. 1986;26(11):970-979.

Cox EF. Blunt abdominal trauma. A 5 year analysis of 870 patients requiring celiotomy. Ann of Surg.1984 Apr;199(4): 467-474.

Carmona RH, Lim Jr RC, Clark GC. Morbidity and mortality in hepatic trauma: a 5 year study. The American J Surg. 1982;144(1):88-94.

Trunkey DD. Recent trends in management of hepatic trauma. J Trauma. 1991; 460-4.

Falimirski ME, Provost D. Non-surgical management of solid abdominal injury in patients of over 55 years of age. Am J Surg. 2000;66(7):631-5.

Carrillo EH, Platz A, Miller FB, Richardson JD, Polk HC Jr. Non-operative management of blunt hepatic trauma. Br J Surg. 1998;85(4):461-8.

Goldstein AS, Sclafani SJ, Kupferstein NH, Bass IS, Lewis TH, Panetta T, Phillips TH, Shaftan GW. The diagnostic superiority of computerized tomography. J Trauma. 1985;25(10):938-46.

Nelson EW, Holliman CJ, Juell BE, Mintz S. CT in evaluation of Blunt Abdominal trauma. Am J Surg. 1983;146(6):751-4.

Matsubara TK, Fong HM, Burns CM. Computed tomography of abdomen (CTA) in management of blunt abdominal trauma. J Trauma. 1990;30(4):410-4.

Myers JG, Dent DL, Stewart RM, Gray GA, Smith DS, Rhodes JE et al. Blunt splenic injuries: dedicated trauma surgeons can achieve a high rate of non-operative success in patients of all ages. J Trauma. 2000;48(5):801-805.

Croce MA, Fabian TC, Menke PG, Waddle-Smith L, Minard G, Kudsk KA, et al. Nonoperative management of blunt hepatic trauma is the treatment of choice for hemodynamically stable patients. Results of a prospective trial. Ann Surg. 1995;221(6):744-53.

Brasel KJ, Delisle CM, Olson CJ, Borgstrom DC. Trends in the management of hepatic injury. Am J Surgery. 1997;174(6):674-7

Bonariol L, Massani M, Caratozzolo E, Recordare A, Callegari P, Antoniutti M, et al. Selection criteria for non-surgical treatment of liver injury in adult polytraumatized patients. Chir Ital. 2002;54(5):621-18.

Parks RW, Chrysos E, Diamond T. Management of liver trauma. British J Surg. 1999;86(9):1121-35.

Aseervatham R, Muller M. Blunt trauma to the spleen. Aust New Zealand J Surg. 2000;70(5):333-7.

Nix JA, Costanza M, Daley BJ, Powell. Outcome of current management of Splenic injuries. J Trauma 2001;50(5):835-842.

Bee TK, Croce MA, Miller PR, Pritchard FE, Fabian TC. Failures of splenic NOM-is the glass half empty or half full? J Trauma. 2001;50(2):230-236.

Meguid AA, Bair HA, Howells GA, Bendick PJ, Kerr HH, Villalba MR. Prospective evaluation for the non-operative management of blunt splenic trauma. Am J Surg. 2003;69(3):238-243.

Shapiro MJ, Krausz C, Durham RM, Mazuski JE. Overuse of splenic scoring and computed tomographic scans. J Trauma Acute Care Surg. 1999;47(4):651.

Peitzman AB, Heil B, Rivera L, Federle MB, Harbrecht BG, Clancy KD, et al. Blunt splenic injury in adults: Multi-institutional Study of the Eastern Association for the Surgery of Trauma. J Trauma. 2000;49(2):177-87.