Prise en charge des traumatismes fermés du foie

Management of blunt hepatic trauma (BHT) has progressed these two last decades thanks to non-operatory treatment (NOT) witch remains the “Gold Standard” for low grades traumas, with 80 to 90% of patients treated non operatively. Clinical examination, blood tests and CT scan allow choosing NOT as primal treatment and switching to surgical treatment at each moment if it gets necessary. On the other hand NOT of BHT has led to increasing of tardive complications frequency. Most frequent complications are resumption of bleeding, bile leaks and fistulas, abdominal compartment syndromes, liver necrosis and abscesses. These complications can be managed surgically by coeliotomy or laparoscopy, interventional radiology, and endoscopic procedures according to the patient state and after multidisciplinary discussion. This kind of management can be considered as a late one and be done in conventional conditions. It must not be considered as a failure of NOT but as a complete part of it.