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Non-operative management of blunt injury to the liver or spleen requires the patient to be haemodynamically normal and have no signs of peritonitis on physical examination.

For physical examination to be reliable the patient must be fully alert and orientated, with no drugs or alcohol. There must be no spinal cord injury or other factor that might render abdominal examination unreliable. Development of peritonitis may indicate a ruptured hollow viscus - small bowel perforation being the most likely in this patient.

Haemodynamically stable patients who only maintain their blood pressure by the constant infusion of crystalloid or blood products are not haemodynamically normal, have ongoing haemorrhage, and need surgical intervention.

CT scan findings and grade of injury are not, in themselves, criteria for laparotomy. However more severe grades of injury are more likely to require laparotomy.

Non-operative management does not equate to conservative management. It is an active process of constant monitoring and re-examination, in a high-dependency area. If the patient becomes haemodynamically unstable or develops peritonitis, laparotomy is indicated.