Nonoperative management of abdominal solid-organ injuries following blunt trauma in adults: Results from an International Consensus Conference

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Nonoperative management (NOM) is an initial nonsurgical management strategy of a solid-organ injury which usually consists of observation, but may include use of endovascular, percutaneous, or endoscopic procedures. Nonoperative management for blunt solid organ injuries has become the standard of care for patients who are hemodynamically stable, without other indications for exploratory laparotomy.1 This is particularly true, since the mid-1990s, for spleen injuries, with a success rate which has increased in some reports as high as 95%.2–8
Liver injuries have a reported success rate of 95% for NOM.9 The data about NOM for pancreatic trauma is less clear,10–12 but NOM may be safe and effective in selected patients,13,14 even in grades III to IV injuries.15 Nonoperative management has become the preferred way of managing blunt kidney injuries,16–19 even for high-grade injuries, with a reported overall success rate greater than 80%.20,21
Computed tomography (CT)22 allows clinicians to recognize and grade solid-organ injuries23–25 and to rule out possible contraindications to NOM.
Moreover, the implementation of angioembolization (AE)26–30 and endoscopic procedures31,32 has expanded the role of NOM, treating vascular injuries which include active bleeding (extravasation) and nonbleeding vascular injuries (pseudoaneurysm [PSA] and arteriovenous fistula), as well as managing complications in stable patients.33–36
The aim of the International Consensus Conference (ICC) on NOM of solid-organ injuries held in Milan in December 2016 was to develop evidence-based guidelines to identify the indications for NOM in adult blunt trauma patients to choose the best and most appropriate modality for follow-up, as well as the best technique to manage complications.
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