In ATLS-based management of blunt liver trauma, a Grade IV hepatic injury (laceration involving 25–75% of hepatic lobe) in a haemodynamically stable patient is best managed by:

• A Emergency exploratory laparotomy and formal hepatic resection
• B Damage control laparotomy with perihepatic packing and ICU resuscitation regardless of haemodynamic status
• C Immediate transfer to hepatobiliary surgeon for right hepatectomy
• D Non-operative management (NOM) with angioembolization if active contrast blush is identified on CT ✓

Explanation

The management paradigm for blunt liver trauma has shifted to non-operative management in haemodynamically stable patients regardless of injury grade. In Grade IV injuries, NOM success rates exceed 85% in stable patients. CT identification of an active arterial blush or pseudoaneurysm is the primary indication for angiography and selective hepatic artery embolization, which has largely replaced operative intervention for ongoing haemorrhage in stable patients. Damage control laparotomy is reserved for haemodynamically unstable patients not responding to resuscitation.

Reference: Bailey & Love's Short Practice of Surgery, 27th ed.

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Written and medically reviewed by the StethoPrep medical team.