Doctor examining holographic liver and spleen model

Beyond the Scalpel: A Modern Guide to Non-Operative Management of Liver and Spleen Injuries

Rhea Morgan in Health & Wellness August 2025 • 4 min read.

"Discover practical strategies and the value of radiological scoring systems in treating blunt hepatic and splenic injuries without surgery."

Blunt abdominal trauma is a common and serious issue, especially with the rise in sports-related injuries. Managing these types of injuries requires a comprehensive approach, considering the potential for complex clinical scenarios involving abdominal, thoracic, limb, and head trauma.

Traditionally, surgery was the go-to solution for liver and spleen injuries. However, modern approaches increasingly favor non-operative management (NOM) when appropriate. This shift is due to concerns about post-operative complications and the recognition that many injuries can heal on their own with careful monitoring.

NOM is considered safe when a trauma center offers 24/7 access to experienced surgeons, advanced imaging, intensive care units (ICUs), and other critical support services. This approach has been shown to reduce hospital costs, minimize unnecessary surgeries, lower complication rates, decrease the need for blood transfusions, and improve overall patient outcomes.

Is Non-Operative Management Right for You? Key Patient Selection Criteria

Doctor examining holographic liver and spleen model

Choosing the right treatment path starts with careful patient selection. Haemodynamic stability is the primary factor when considering NOM for blunt hepatic and splenic injuries. While some protocols list contraindications like advanced age or high-grade injuries, most decisions are based on individual assessments rather than strict rules.

Patients who are haemodynamically unstable or show signs of peritonitis typically require surgery. Adjunct interventions like angiography, endoscopic retrograde cholangiopancreatography (ERCP), or laparoscopy may also be necessary. Clear guidelines are lacking on aspects like frequency of clinical exams, imaging, haemoglobin measurements, monitoring intensity, and when to consider operative intervention.

Frequency of Clinical Examination: How often should patients be checked?
Imaging Procedures: Which imaging techniques are most effective?
Haemoglobin Measurements: How often should haemoglobin be measured, and what levels indicate intervention?
Monitoring Intensity: How closely should patients be monitored?
Transfusion Triggers: At what point should operative or angiographic intervention be considered?
Oral Intake: When can patients resume eating?
Restricted Activity: How long should activity be limited, both in the hospital and after discharge?
Length of Stay: What is the appropriate length of stay in the ICU and hospital?
Thromboembolic Prophylaxis: When should measures to prevent blood clots be initiated?
Post-Splenic Injury Vaccines: Are vaccines needed, and when should they be administered?

This article focuses on the latest recommendations for practical management, including a review of injury scales. Evidence-based grades from the Oxford Centre for Evidence-Based Medicine are used.

The Future of Non-Operative Management

NOM for liver and spleen injuries is becoming more common, but high-quality evidence from well-designed trials is still needed. Many questions, including those about daily life, remain unanswered. Developing clear protocols and conducting regular audits are crucial steps toward improving outcomes and reducing unnecessary surgeries. Surgery remains the best option in some cases and should be used when needed. Combining standardized procedures with other techniques may increase overall success rates and avoid unnecessary operations.

About this Article -

This article was crafted using a human-AI hybrid and collaborative approach. AI assisted our team with initial drafting, research insights, identifying key questions, and image generation. Our human editors guided topic selection, defined the angle, structured the content, ensured factual accuracy and relevance, refined the tone, and conducted thorough editing to deliver helpful, high-quality information.See our About page for more information.

Everything You Need To Know

What factors determine if Non-Operative Management (NOM) is suitable for blunt hepatic and splenic injuries?

Patient selection is key in determining suitability for Non-Operative Management (NOM). Haemodynamic stability is the primary factor. Patients who are haemodynamically unstable or exhibit signs of peritonitis typically require surgery. Advanced age or high-grade injuries are not strict contraindications, but rather, individual assessments guide the decision. The availability of 24/7 access to experienced surgeons, advanced imaging, intensive care units (ICUs), and other critical support services at a trauma center is also crucial for the safety and success of NOM. This approach helps reduce hospital costs, minimize unnecessary surgeries, lower complication rates, decrease the need for blood transfusions, and improve overall patient outcomes.

How does Non-Operative Management (NOM) for liver and spleen injuries compare to traditional surgical approaches?

Traditionally, surgery was the primary solution for liver and spleen injuries. However, modern approaches increasingly favor Non-Operative Management (NOM) when appropriate. NOM has been shown to reduce hospital costs, minimize unnecessary surgeries, lower complication rates, decrease the need for blood transfusions, and improve overall patient outcomes. This shift recognizes that many injuries can heal on their own with careful monitoring. Surgery remains the best option in some cases, especially for patients who are haemodynamically unstable or show signs of peritonitis. The availability of a trauma center with 24/7 access to experienced surgeons, advanced imaging, intensive care units (ICUs), and other critical support services is essential to ensure the safety of NOM.

What specific aspects of patient care lack clear guidelines within the context of Non-Operative Management (NOM)?

Clear guidelines are lacking on various aspects of Non-Operative Management (NOM). These include the frequency of clinical exams, the most effective imaging techniques, the frequency of haemoglobin measurements and the levels that indicate intervention, the intensity of monitoring, transfusion triggers, when patients can resume oral intake, the duration of restricted activity, the appropriate length of stay in the ICU and hospital, when to initiate thromboembolic prophylaxis, and the need for post-splenic injury vaccines and their administration schedule. Addressing these gaps through the development of clear protocols is vital for improving outcomes and standardizing care.

What are the potential benefits of using Non-Operative Management (NOM) for blunt liver and spleen injuries?

Non-Operative Management (NOM) offers several advantages. It can reduce hospital costs, minimize unnecessary surgeries, lower complication rates, decrease the need for blood transfusions, and improve overall patient outcomes. By carefully monitoring patients and allowing the body to heal naturally when possible, NOM avoids the risks associated with surgery, such as post-operative complications. The success of NOM depends on careful patient selection, the availability of comprehensive support services at the trauma center, and the development of clear protocols to guide care. It is important to remember that surgery remains the best option in certain cases, such as when patients are haemodynamically unstable or show signs of peritonitis.

What future developments are anticipated in the field of Non-Operative Management (NOM) for liver and spleen injuries?

The field of Non-Operative Management (NOM) for liver and spleen injuries is evolving, with the practice becoming more common. The need for high-quality evidence from well-designed trials is crucial. More research is needed to answer many questions, including those related to daily life aspects. Developing clear protocols and conducting regular audits are seen as essential steps toward improving outcomes and reducing unnecessary surgeries. Combining standardized procedures with other techniques is expected to increase overall success rates and avoid unnecessary operations. The use of evidence-based grades from the Oxford Centre for Evidence-Based Medicine is also an important aspect of the advancement.