Ho, ho, ho! Gather around, my dear friends, as I tell you a tale from the frosty archives of a level I trauma center, a story spanning over two decades, from January 1996 to June 2020, about the adventurous journey of managing liver trauma. Now, liver injuries, much like deciding who’s naughty or nice, can be quite tricky and come in two main types: the blunt, akin to a snowball hitting you unexpectedly, and the penetrating, much like a sharp icicle.

In our story, 406 brave souls encountered liver trauma, with a whopping 92.4% experiencing the blunt kind, much like a surprise snowball fight, and a daring 7.6% facing the penetrating kind, as if dodging icicles. Now, in the magical world of trauma care, there’s a preference for treating these injuries without surgery, much like how I prefer to deliver presents without getting stuck in the chimney. This method, known as non-operative management (NOM), is like using magic to heal, but the criteria for choosing this path were as unclear as a blizzard night.

Our heroes, the medical elves, discovered that about one-third of these patients were as unstable as a sleigh on a rooftop, yet a surprising 78.8% had low-grade liver lesions, as minor as finding coal in your stocking. The first choice of treatment was non-operative in 72.9% of cases, with a sprinkle of conservative care in 68.5% and a dash of interventional radiology in 4.4%. For those who faced the blunt trauma, surgery was needed in 23.2% of cases, while the icicle dodgers, with penetrating trauma, required surgery in 74.2% of instances.

The overall mortality was 11.1%, including those who couldn’t be saved by the magic of Christmas due to associated lesions. The 24-hour mortality stood at 5.7%, reminding us that not all stories have a happy ending. The sleigh bells of surgery rang for those who were hemodynamically unstable, had high-grade liver lesions, faced the sharp icicles of penetrating trauma, or had severe associated lesions.

In conclusion, my dear friends, while the role of surgery in liver trauma management has diminished over the years, much like the use of coal in stockings, it remains crucial for those facing the most severe challenges. In other cases, NOM, with its magical blend of conservative therapy or radiological embolisation, proves to be an effective potion. So, as we close this chapter, let’s remember the bravery of those who face liver trauma and the skilled elves who care for them, ensuring that the spirit of healing, much like the spirit of Christmas, remains alive and well.