Grade - V [AAST Classification] Acute Liver Injury Managed via Non-Surgical Approach: A Case Report:

Raja Khalid Shabbir; Mashood Iqbal; Muhammad Saad

doi:10.29054/apmc/2024.1453

Raja Khalid Shabbir Post-Graduate Trainee, Department of Neurosurgery, Holy Family Hospital, Rawalpindi Medical University, Rawalpindi, Pakistan
Mashood Iqbal Resident Medical Officer, Department of Internal Medicine, Jinnah Medical and Dental College, Karachi Pakistan
Muhammad Saad Medical Officer, Shaikh Zayed Hospital, Lahore Pakistan

DOI: https://doi.org/10.29054/apmc/2024.1453

Keywords: Blunt trauma, Liver trauma, Liver injury, ATLS, Non-operative management [NOM], CT-imaging, Surgical exploration

Abstract

Blunt abdominal traumas involving the liver are frequently encountered as part of Road Traffic Accidents [RTA]. Despite aggressive management and resuscitation efforts when encountering such patients in the Emergency Room [ER], the concept of developing trauma centers appears mandatory for prompt intervention and therapeutic accuracy. Hemodynamic status appears to play a key role in initiating further treatment strategy. Radiographic imaging namely CT-scans have an established role and has been a gold standard in diagnosing the gravity of the underlying organ injury. Non-Operative Management [NOM] of traumatic liver injury has been considered feasible for grade I - III liver injuries primarily. Surgical exploration of the liver has been restricted to cases of penetrating trauma associated with traumatic liver hemorrhage. Here in, we report a case of a young male who presented in the surgical ER of a tertiary care teaching hospital after his car collided with a tree. ATLS [Advanced Trauma Life Support] protocol was delivered successfully. The patient was resuscitated and further investigations carried out accordingly. CECT [Contrast-Enhanced Computed Tomography] scan of the abdomen revealed grade - V [AAST Classification] acute liver injury which was managed conservatively. Patient was ultimately followed in the surgical Outpatient Department [OPD] after 1 week, 2 weeks, 1 month, and then 3 months of discharge from the hospital with his visits being uneventful.