Pachter et al, in a multicenter study with 13 Level I Trauma Centers in the USA, reported

a 98.5% rate of success in nonoperative treatment for selected patients [7, 8, 12, 15–18]. Severe liver injuries (grade III, IV and V) have higher morbidity this website and mortality. In a study with 170 patients with hepatic trauma, Rizoli et al observed a total of 10 deaths, all with grade IV and V injuries. Many surgeons choose to operate complex lesions of the liver even in patients admitted with hemodynamic stability, fearing a possible rebleeding of liver injury. It is known that the liver rebleeding in patients admitted with hemodynamic stability and with no blush on CT scan, is a rare event [2, 6, 16, 19]. Patients admitted with severe liver injuries tend to be more critical. The average ISS of patients in this study was 24.1. Kozar et al found an average of ISS 28 for patients with grade IV blunt hepatic trauma. In other studies involving patients with blunt or penetrating liver trauma with grade IV and V injuries, Z-DEVD-FMK purchase submitted to surgical treatment or non-surgical, the average ISS was 25, 33, 34 and 36 Temsirolimus respectively [2, 6, 20–22]. None of the patients in our study died, in agreement with other studies showing that nonoperative treatment for grade

IV blunt hepatic trauma is safe for selected patients [5, 22]. In this study we observed that none of the 18 patients developed any complications related to the liver and three patients developed non-liver related complications. Kozar et al found complications in 19 of 92 patients (21%) with grade IV injuries treated nonoperatively. Of these patients, less than a half needed some kind of surgical intervention. Duane et al reported a complication rate of 0% for patients with grade IV blunt liver injury that did not undergo surgery or angioembolization [6, 22]. Only one of the 18 patients P-type ATPase studied herein required surgical conversion secondary to abdominal pain, showing a success rate of 94.5% of nonoperative treatment. In a study with patients with grades III and IV hepatic trauma Coimbra et al, related that 22% of

patients undergoing nonoperative treatment needed surgical intervention. In another study with 230 patients with grades III, IV and V blunt hepatic trauma treated nonoperatively, Kozar et al had 12 patients (5.2%) who failed with nonoperative management and required surgical intervention [5, 6]. The abdominal CT scan is the diagnostic modality of choice for hemodynamically stable patients with suspected abdominal injuries. CT scan has some advantage over ultrasound exam. CT is less operator-dependent and is not limited by the abdominal wall, subcutaneous emphysema, obesity or intestinal distention. CT is very important to diagnose abdominal injuries in patients with neurological damage, since physical examination is feasible in no more than 16% of these patients [12, 22–27].