NONOPERATIVE MANAGEMENT OF BLUNT HEPATIC-TRAUMA

Abdominal CT scanning makes nonoperative management of liver injury po ssible. We reviewed medical records of 56 blunt trauma patients with h epatic injury who received initial abdominal CT scan. We examined: 1) Indications for delayed surgery; 2) Disposition or cause of death; 3) Results of follow up CT scans; 4) Long term complications. Over a 53 m onth period, 1597 patients were admitted for blunt trauma, of which 76 patients were found to have hepatic injury. Twenty patients presented either clinically unstable or with an acute abdomen and underwent dia gnostic peritoneal lavage or immediate laparotomy without a CT scan. A bdominal CT scan was performed on 56 patients, 19 of whom had hepatic injury or associated major abdominal injury and underwent laparotomy. One patient died of cardiac arrhythmias following CT scanning. The rem aining 36 patients received initial nonoperative management of their h epatic injury. Three patients in this group underwent delayed abdomina l surgery. Two developed an acute abdomen. One had a planned nephrecto my. No patient required surgical treatment of their liver injury at th e time of laparotomy. Four deaths occurred in the 36 patients managed nonoperatively, all due to associated extraabdominal injuries. Ninetee n patients had 27 CT scans taken as follow up examination at intervals of 1 to 94 days postinjury. All of the CT scans showed stabilization or improvement of hepatic injury. Three patients who had CT scans take n at 3 months postdischarge were asymptomatic, with radiologic resolut ion of their hepatic injury. Nineteen patients were followed for an av erage of 61.8 days (range 7-203 days) after discharge with no complica tions from liver injury. We conclude that nonoperative management of b lunt hepatic injury is an appropriate option in selected patients, and that long term follow up CT scans may not be necessary in asymptomati c patients.