Long-Term Follow-Up After Non-operative Management of Blunt Splenic and Liver Injuries: A Questionnaire-Based Survey

World J Surg. 2018 May;42(5):1358-1363. doi: 10.1007/s00268-017-4336-5.


Background: Non-operative management (NOM) of blunt splenic or liver injuries (solid organ injury, SOI) has become the standard of care in hemodynamically stable patients. However, the incidence of long-term symptoms in these patients is currently not known. The aim of this study was to assess long-term symptoms in patients undergoing successful NOM (sNOM) for SOI.

Methods: Long-term posttraumatic outcomes including chronic abdominal pain, irregular bowel movements, and recurrent infections were assessed using a specifically designed questionnaire and analyzed by univariable analysis.

Results: Eighty out of 138 (58%) patients with SOI undergoing sNOM) responded to the questionnaire. Median (IQR) follow-up time was 48.8 (28) months. Twenty-seven (34%) patients complained of at least one of the following symptoms: 17 (53%) chronic abdominal pain, 13 (41%) irregular bowel movements, and 8 (25%) recurrent infections. One female patient reported secondary infertility. No significant association between the above-mentioned symptoms and the Injury Severity Score, amount of hemoperitoneum, or high-grade SOI was found. Patients with chronic pain were significantly younger than asymptomatic patients (32.1 ± 14.5 vs. 48.3 ± 19.4 years, p = 0.002). Irregular bowel movements were significantly more frequent in patients with severe pelvic fractures (15.4 vs. 0.0%, p = 0.025). A trend toward a higher frequency of recurrent infections was found in patients with splenic injuries (15.9 vs. 2.8%, p = 0.067).

Conclusion: A third of patients with blunt SOI undergoing sNOM reported long-term abdominal symptoms. Younger age was associated with chronic abdominal symptoms. More studies are warranted to investigate long-term outcomes immunologic sequelae in patients after sNOM for SOI.

Publication types

  • Observational Study

MeSH terms

  • Abdominal Pain / epidemiology
  • Adult
  • Chronic Pain / epidemiology
  • Conservative Treatment*
  • Constipation / epidemiology
  • Female
  • Follow-Up Studies
  • Humans
  • Infections / epidemiology
  • Liver / injuries*
  • Male
  • Middle Aged
  • Recurrence
  • Spleen / injuries*
  • Surveys and Questionnaires
  • Switzerland / epidemiology
  • Wounds, Nonpenetrating / epidemiology
  • Wounds, Nonpenetrating / therapy*
  • Young Adult