Successful non-operative management of penetrating liver injury without interventional radiology back up

Introduction: The selective non-operative management (NOM) of penetrating liver injury is gaining increasing acceptance, but requires expertise and it should be done with in house intervention radiology (IR) back up. Some level 1 trauma centers in Brazil do not have this resource. We describe a series of patients with penetrating liver injuries evaluated for NOM. Our goal is to show that successful NOM is possible even without the IR back up. Methods: A protocol-driven study was done including all patients with penetrating liver injuries admitted to a level I trauma center, over a 12-month period elected for NOM. The initial evaluation included detailed physical examination and contrast CT scan for all patients. Results: During the study period, there were 15 patients with penetrating liver injuries evaluated for NOM. The majority were men (86%) and the mean age was 29 years. Gunshot wounds accounted for 73% and stab wounds for the remaining 27%. Ten patients underwent laparotomy mostly due to the impossibility of excluding hollow viscera lesion. Overall 5 patients (33%), including 2 cases with grade III injuries, were successfully managed without a laparotomy or IR procedure and without any abdominal complication. Conclusions: Our successful rate is compatible with the best results from recent literature, showing that selective non-operative management of penetrating liver injuries can be done even in a service without IR.