Liver and Spleen Injury Management in Combat (Old School)
The management of hepatic and splenic injuries on the “homefront” has changed dramatically since the mid 1990s. The impetus for this change has been driven largely by improvements in diagnostic and interventional capabilities facilitating non-operative therapeutic strategies for blunt trauma. This chapter is not written with the “homefront” in mind. The deployed surgeon is often faced with complex challenges which must be dealt with using only a modicum of diagnostic information and clinical judgment. In the civilian setting, most of us have become experts at managing liver and spleen injuries by taking a lot of pretty pictures of them and sometimes calling in Interventional Radiology to control active bleeding. In the combat setting, you can expect to actually operate on the spleen and even the dreaded liver. Have a battle plan in mind before you make your incision, keep it simple, and you will become the master of the solid organs.