ABSTRACT
The liver is the most commonly injured organ in patients with blunt abdominal trauma and the second most common in penetrating abdominal trauma. Less than 20% of patients with blunt liver injury will require emergent laparotomy because of either the liver or associated intraabdominal injuries. Associated intraabdominal injuries necessitating laparotomy, peritonitis, hemodynamic instability, and lack of appropriate clinical environment and/or availability of facilities or personnel to support adjuncts to NOM should the need arise constitute the four absolute contraindications to NOM. Based on the aforementioned criteria, more than 80% of blunt trauma patients are candidates for NOM, with a success rate of around 90%. In March 2010, the EAST published practice management guidelines for sNOM of penetrating abdominal trauma, which specifically addressed the indications for laparotomy for GSWs, postinjury imaging, and specific recommendations for sNOM.
