Liu SY, Shankara GS, Yang SY and Liu ZJ
Background: Gingival Non-operative management (NOM) has evolved into the treatment of choice for most patients with blunt liver injuries who are hemodynamically stable. However, there are still evidence of patients at higher risk for NOM failure. These patients must be treated more cautiously regarding the NOM approach.
Method: The failure of four high grade blunt hepatic trauma cases treated with NOM was reviewed in recent three years in our hospital.
Results: Four patients with high grade liver trauma (three grade Ⅳ, one grade Ⅴ) were initially hemodynamically stable and treated with NOM. Several hours later, their heart rates increased rapidly, and blood pressure decreased and underwent surgery. One patient died just on opening the abdominal cavity due to massive bleeding while the other three were saved.
Conclusion: Non-operative management should be very cautious for high grade blunt hepatic trauma patients although they are early hemodynamically stable
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