Nonoperative Management

Liver injuries grade I-III should be treated non-operatively. In case of active bleeding (diagnosed by CT scan), an angiographic embolization should be performed in patients with injuries grade I-IV. However, the following conditions should be fulfilled:

■ Patient without altered level or loss of consciousness

■ Hemodynamic stability or rapid stabilization after initial fluid resuscitation

■ Exclusion of hypothermia, acidosis or severe coagulopathy

■ No doubt about another abdominal lesion

■ Intensive care unit available with continuous pulse and arterial blood pressure monitoring, repeated measurements of Hb, Hct and coagulation parameters, and careful follow-up clinical examination and sonography

■ Availability of a surgical team

■ Arteriography and experienced radiologist available

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