From the Guidelines
Grade 1 liver lacerations should be managed conservatively with non-operative management (NOM) as the treatment of choice, as long as the patient is hemodynamically stable and there are no other internal injuries requiring surgery 1. The management of grade 1 liver lacerations involves several key components, including:
- Hemodynamic monitoring in a hospital setting for 24-48 hours to detect any signs of bleeding or instability
- Serial clinical evaluations, including physical exams and laboratory testing, to detect any change in clinical status during NOM 1
- CT scan with intravenous contrast on admission to confirm the diagnosis and rule out other injuries 1
- Bed rest initially, with gradual mobilization as the patient stabilizes
- Pain management with acetaminophen and opioids as needed
- Intravenous fluids to maintain adequate hydration and blood pressure
- Laboratory tests, including liver function tests, coagulation studies, and complete blood count, should be monitored daily
- Abdominal CT scan is typically performed on admission, but repeat imaging is only necessary if clinical deterioration occurs
- Most grade 1 lacerations heal spontaneously within 4-6 weeks, and follow-up imaging at 4-6 weeks is recommended to confirm healing
- Activity restrictions should include avoiding strenuous physical activity and contact sports for 6-8 weeks It's also important to note that:
- Mechanical prophylaxis is safe and should be considered in all patients with no absolute contraindication 1
- LMWH-based prophylaxis should be started as soon as possible following trauma and may be safe in selected patients with liver injury treated with NOM 1
- Early mobilization should be achieved in stable patients, and enteral feeding should be started as soon as possible in the absence of contraindications 1
From the Research
Management of Grade 1 Liver Lacerations
- The management of liver trauma, including grade 1 liver lacerations, has evolved over the years, with a trend towards non-operative treatment 2.
- Non-operative management (NOM) is considered safe and effective for hemodynamically stable patients with low-grade liver trauma, including grade 1 liver lacerations 3, 4.
- A study on non-operative management of isolated liver trauma found a high success rate of 97.2% for NOM, with a success rate of 100% for grade I-III liver trauma 4.
- Another study found that non-operative management of high-grade blunt hepatic injuries, including grade 1 liver lacerations, can be safely accomplished with a low mortality rate, but complications should be anticipated and may require a combination of operative and non-operative management strategies 5.
- The healing process of blunt liver injury after non-operative management can be monitored using ultrasonography, with a median time for liver repair ranging from 30 to 118 days depending on the grade of injury 6.
Key Considerations
- Hemodynamic stability is a crucial factor in determining the suitability of non-operative management for liver trauma, including grade 1 liver lacerations 3, 2.
- The grade of liver injury and the volume of hemoperitoneum are not suitable criteria for selecting non-operative management 4.
- Hepatic angioembolization associated with the correction of hypothermia, coagulopathy, and acidosis is important in the conservative treatment for liver trauma 4.
- Complications such as bleeding, liver abscesses, and biliary complications can occur in patients with high-grade liver injuries, including grade 1 liver lacerations, and may require operative or non-operative management strategies 5.