A prospective and retrospective study on conservative management of hepatic and splenic injury following blunt abdominal trauma


  • Induchoodan Ponnamma Pillai Sukumaran Nair Department of General Surgery, Government Medical College, Thiruvananthapuram, Kerala, India http://orcid.org/0000-0002-6924-2724
  • Rajesh P. S. Department of General Surgery, Government Medical College, Kottayam, Kerala, India




Blunt abdominal trauma, Conservative management, Liver injury, Splenic injury, Road traffic accidents, Hemodynamic stability


Background: worldwide road traffic accidents accounts as the leading cause of death of young people. For a very long time most of the intra-abdominal injuries following blunt abdominal trauma were managed operatively. Conservative management is becoming more acceptable and effective management option for blunt abdominal trauma during the last few decades.

Methods: This study was conducted in Government Medical College, Kottayam during September 2007 to December 2008. All conservatively managed blunt abdominal trauma patients during the study period were included in the study.

Results: Out of 22 patients, 4 patients failed conservative management. Success rate was 81%. Most commonly injured solid organ in the study group was liver (77%). Maximum cases were of age group 10 to 20 (31.81%) years. 81% of patients were males. Motor vehicle accident was the most common cause of trauma (77%). Mean stay in intensive care unit was 4.2 days and mean hospital stay was 15.7 days. Mean systolic blood pressure was 110 mmHg ranging from 70 to 130 mmHg. 50% of patients had moderate hemoperitoneum and non-had massive hemoperitoneum.

Conclusions: Non operative management is safe and effective approach in blunt spleen and liver injuries. Non operative management should be treatment of choice for all hemodynamically stable patients with blunt liver and splenic trauma.

Author Biographies

Induchoodan Ponnamma Pillai Sukumaran Nair, Department of General Surgery, Government Medical College, Thiruvananthapuram, Kerala, India

Assistant professor 

Department of General Surgery 

Rajesh P. S., Department of General Surgery, Government Medical College, Kottayam, Kerala, India

Additional Professor, Dept of General Surgery


Road traffic injuries, WHO. Available at: https://www.who.int/health-topics/road-safety#tab= tab_1. Accessed on 3 December 2019.

Cimbanassi S, Chiara O, Leppaniemi A, Henry S, Scalea TM, Shanmuganathan K, et al. Nonoperative management of abdominal solid-organ injuries following blunt trauma in adults: Results from an International Consensus Conference. J Trauma Acute Care Surg. 2018;84(3):517-31.

Raza M, Abbas Y, Devi V, Prasad KV, Rizk KN, Nair PP. Non operative management of abdominal trauma - a 10 years review. World J Emerg Surg. 2013;8:14.

Liver Injury Scale. Injury Scoring Scale. A Resource for Trauma Care Professionals. Available at: https://www.aast.org/library/traumatools/injury-scoringscales.aspx#liver. Accessed on 3 December 2019.

Spleen Injury Scale. Injury Scoring Scale. A Resource for Trauma Care Professionals. Available at: https://www.aast.org/library/traumatools/injury scoringscales.aspx#spleen. Accessed on 3 December 2019.

Fransvea P, Costa G, Massa G, Frezza B, Mercantini P, BaIducci G. Non-operative management of blunt splenic injury: is it really so extensively feasible: a critical appraisal of a single-center experience. Pan Afr Med J. 2019;32:52.

King H, Shumacker HB. Splenic studies In Susceptibility to infection after splenectomy performed in infancy. Ann Surg. 1952;136(2):239-42.

Pringle JHV. Notes on the Arrest of Hepatic Hemorrhage Due to Trauma. Ann Surg. 1908;48(4):541-9.

Upadhyaya P. Conservative management of splenic trauma: history and current trends. Ped Surgery Int. 2003;19:617-27.

Meyer DM, Thal ER, Coln D, Weigelt JA. Computed tomography in the evaluation of children with blunt abdominal trauma. Ann Surg. 1993;217(3):272-6.

Federle MP, Griffiths B, Minagi H, Jeffrey RB. Splenic trauma: evaluation with CT. Radiology. 1987;162(1-1):69-71.

Pachter HL, Knudson MM, Esrig B, Ross S, Hoyt D, Cogbill T, et al. Status of nonoperative management of blunt hepatic injuries in 1995: a multicenter experience with 404 patients. J Trauma. 1996;40(1):31-8.

Pachter HL, Spencer FC, Hofstetter SR, Liang HG, Coppa GF. Significant trends in the treatment of hepatic trauma. Experience with 411 injuries. Ann Surg. 1992;215(5):492-500.

Croce MA, Fabian TC, Menke PG, Smith WL, 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.

Schurr MJ, Fabian TC, Gavant M, Croce MA, Kudsk KA, Minard G, et al. Management of blunt splenic trauma: computed tomographic contrast blush predicts failure of nonoperative management. J Trauma. 1995;39(3):507-12.

Federico JA, Horner WR, Clark DE, Isler RJ. Blunt hepatic trauma. Nonoperative management in adults. Arch Surg. 1990;125(7):905-8.

Fischer RP, Crotchett MP, Reed RL. Gastrointestinal disruption: the hazard of nonoperative management in adults with blunt abdominal injury. J Trauma. 1988;28(10):1445-9.

Parreira JG, Oliari CB, Malpaga JM, Perlingeiro JA, Solda SC, Assef JC. Severity and treatment of ‘occult’ intra-abdominal injuries in blunt trauma victims. Injury. 2016;47(1):89-93.

On BZ, Ohry A. The acute abdomen in spinal cord injury individuals. Paraplegia. 1995;33(12):704-6.

Sherck J, Shatney C, Sensaki K, Selivanov V. The accuracy of computed tomography in the diagnosis of blunt small-bowel perforation. Am J Surg. 1994;168(6):670-5.

Jha NK, Yadav SK, Sharma R. Characteristics of Hollow Viscus Injury following Blunt Abdominal Trauma; a Single Centre Experience from Eastern India. Bull Emerg Trauma. 2014;2(4):156‐60.

Afifi I, Abayazeed S, Menyar EA, Abdelrahman H, Peralta R, Thani AH. Blunt liver trauma: a descriptive analysis from a level I trauma center. BMC Surg. 2018;18(1):42.

Umali E, Andrews HG, White JJ. A critical analysis of blood transfusion requirements in children with blunt abdominal trauma. Am Surg. 1992;58(12):736-9.

Stawicki SP. Trends in nonoperative management of traumatic injuries - a synopsis. Int J Crit Illn Inj Sci. 2017;7(1):38‐57.






Original Research Articles