Nonoperative management of solid organ injuries - Past, present, and future

Growing experience with the nonoperative approach to the management of solid organ injuries demonstrates that most pediatric and adult patients with liver, splenic, and renal injuries can be managed safely without operation if hemodynamic stability is ensured. It seems that delayed hemorrhage and missed intestinal injuries are unusual in the hands of experienced trauma surgeons. Although abdominal CT scanning is important in the initial staging of these injuries, repeat CT scanning now can be reserved for selected patients with specific indications. Bedside ultrasound may be useful for follow-up of these injuries, and angiographic and endoscopic procedures also have been valuable in patients with vascular injuries or complications following nonoperative management. Elderly patients, patients with underlying splenic pathology, and patients with neurologic injuries also have benefited from the nonoperative approach, although further study of these high-risk groups is warranted. Finally, carefully selected patients with penetrating injuries to the spleen or liver also might be candidates for conservative management.