Changing patterns in diagnostic strategies and the treatment of blunt injury to solid abdominal organs

The purpose of this review is to describe the changes that have been made over the past decades in the management of blunt trauma to the liver, spleen and kidney.The management of blunt abdominal injury has changed considerably. Focused assessment with sonography for trauma (FAST) examination has replaced diagnostic peritoneal lavage as diagnostic modality in the primary survey. MDCT scanning with intravenous contrast is now the gold standard diagnostic modality in hemodynamically stable patients with intra-abdominal fluid detected with FAST. One of the current discussions in the literature is whether a whole body MDCT survey should be implemented in the primary survey.The progress in imaging techniques has contributed to NOM being currently the treatment of choice for hemodynamically stable patients. Angioembolization can be used as an adjunct to NOM and has increased the success rate to 95%. However, to date many controversies exist about the optimum patient selection for NOM, the proper role of angioembolization in NOM, the best technique and material to use in angioembolization, and the right follow-up strategy of patients sustaining blunt abdominal injury. Conducting a well-designed prospective clinical trial or a Delphi study would be preferable.Trauma is the leading cause of death among people who are younger than 45 years [1]. One of the main causes of death after trauma, with numbers ranging from 40 to 80%, is exsanguination caused by injuries to the abdominal organs.The spleen and liver are the most commonly injured organs as a result of blunt trauma [2]. The kidney is also commonly injured [2].Over the past 40 years, many changes in the primary survey and treatment of patients with blunt abdominal trauma have occurred. Traditionally, emergent laparotomy was the standard of care. Currently, nonoperative management (NOM) is the most common management strategy in hemodynamically stable patients. The aim of this review is to describe the shift in management o