THE CURRENT STATUS OF NONOPERATIVE MANAGEMENT OF ADULT BLUNT HEPATIC INJURIES

This review of 14 recent publications encompassing 495 patients highli ghts the current role of the nonoperative management of adult blunt he patic injuries. When careful inclusion criteria were met, the most imp ortant of which is hemodynamic stability, a 94% success rate was achie ved, clearly attesting to the safety and efficacy of this approach. A 0% Liver-related mortality in these 495 patients was achieved, and the re were no documented missed enteric injuries. Delayed hemorrhage that led to laparotomy occurred in 2.8% of patients. The mean length of ho spital stay was 13 days, and the mean transfusion requirement was 1.9 units of blood per patient. Computed axial tomography scanning was ess ential and played an integral role in delineating the extent of the in jury, identifying other intra-abdominal injuries that would mandate im mediate laparotomy, and following the progress of injury resolution. O verall, 34% of blunt liver injuries were managed nonoperatively. As of 1993, however, available data confirms that 51% of adult reported blu nt hepatic injuries have been treated nonoperatively. Rigid adherence to the described guidelines may allow the majority of blunt hepatic in juries to be treated nonoperatively. It should be stressed, however, t hat this method of patient management should only be undertaken at ins titutions where the appropriate resources necessary to deal with this patient population are readily available.