In contrast to splenic injuries, delayed bleeding from the liver in blunt trauma is reported to be rare [63]. However it is the most common vascular complication of NOM of liver injuries, occurring in up to 3% of

patients [55]. A change in the haemodynamic status of any patient having NOM of an abdominal injury mandates urgent CT scan. Figure 5 shows a grade III liver laceration that was initially treated conservatively but the patient required delayed operative management due to clinical deterioration. Complications such as false aneurysm or a posttraumatic arterio-portal fistula are more likely following penetrating injury and are amenable to embolisation [64]. Figure 5 a) Axial contrast enhanced CT of a teenager who

sustained a handlebar injury to the abdomen. Large laceration/haematoma (arrow) and no active extravasation. b) Coronal reconstruction ATM/ATR inhibitor demonstrates free fluid around the right lobe of the liver (arrow) and the extent 17DMAG datasheet of the laceration. He was managed conservatively initially but deteriorated several days later. c) An emergency CT showed a contrast blush (arrow). d) Maximimum intensity projections demonstrated that the most likely cause was the right anterior portal vein (arrow). At operation (not by our team) biliary peritonitis was found but there was no active bleeding and subsequent hepatic angiography was negative. Angiographic related complications are infrequent and as low as 0% [62] though other studies have shown that up to

14% of patients may require re-embolisation due to continued bleeding [56]. Reported complications include; bile collections, hepatic abscess, gallbladder infarction and subcapsular haematoma. Some of these are not a direct result of embolisation but of NOM and the trauma itself [62]. Follow-up CT is warranted for monitoring of NOM of all major hepatic injuries in order to enable early detection of complications such as A-V Carnitine palmitoyltransferase II fistula. Renal injuries Renal injuries may occur after stab and gunshot wounds but are more common after blunt abdominal trauma or iatrogenic following percutaneous renal procedures. Renal trauma comprises up to 24% of injuries resulting from blunt abdominal trauma, third only to splenic and hepatic injuries [65]. Most (over 80%) can be considered minor and heal [66]. Renovascular injuries occur in only 2.2% of all patients with blunt abdominal traumatic injuries [66]. The range of CT appearances includes contusions (seen as ill-defined perfusion defects), superficial lacerations, segmental renal ischaemic infarcts (seen as segmental perfusion defects) and subcapsular or perirenal haematoma. Evaluation of renal injuries requires standard parenchymal phase imaging and delayed nephrogenic phase imaging giving information on the collecting system [40]. This will help differentiate contrast extravasation from the renal pelvis (posttraumatic urinoma) from active haemorrhage from the renal SCH772984 parenchyma.