Usefulness of TAE for severe blunt liver trauma

In patients with severe blunt liver injury who were treated according to our unique protocol, we investigated the treatment results, prognosis, and complications. Among patients with blunt liver injury who were treated in our hospital between January 2005 and March 2010, the subjects were 57 patients meeting the following conditions unstable circulatory kinetics, type I b or III evaluated according to the classification established by the Japanese Association for the Surgery of Trauma, or the extravascular leakage of contrast medium on CT. In FAST-positive non-responders, an emergency laparotomy was performed. In the other patients, angiography was conducted when CT revealed the above findings. In patients with extravascular leakage, transcatheter arterial embolization (TAE) was selected. In those without leakage, conservative treatment was performed. Emergency laparotomy was conducted in 7 patients. Of these, 1 died. Non-operative management (NOM) was carried out in 49 patients (including 27 who underwent TAE). There was no patient in whom NOM was switched to laparotomy, and there was no liver injury-associated death. There were no NOM-related complications requiring surgery in any patient. In patients with blunt liver injury, excluding non-responders, NOM is possible regardless of the morphology of the liver injury. (author)