Nonoperative management of solid abdominal visceral injury: Part II. Liver and kidney

Only in recent years has it been recognized that the injured liver is not only capable of spontaneous hemostasis, but also that it can heal itself remarkably well without surgical intervention. Currently, the approach to stable patients with blunt liver trauma should be nonoperative, regardless of the age of the patient, the degree of liver injury, or the amount of blood in the peritoneal cavity. However, success with this method of management is highly dependent on selection of patients whose liver has ceased bleeding and who do not have an associated intra-abdominal injury in need of operative repair. Similarly, a nonoperative approach is appropriate in patients with blunt renal trauma if the injury is properly staged and if major urinary extravasation and vascular injuries are not present.