Nonoperative management of blunt liver trauma: The value of follow-up abdominal computed tomography scans

Our hypothesis was that follow-up abdominal CT scans are not routinely nece ssary in patients with blunt liver injury treated nonoperatively. We conduc ted an 8-year retrospective review of hospital chart and outpatient clinic records, We reviewed all admission and follow-up CT scans. There were 42 ad ults and 12 children. There were 1 (2%) grade I, 15 (28%) grade II, 28 (52% ) grade III, 8 (15%) grade IV, and 2 (4%) grade V liver injuries. Two patie nts died during the first 24 hours, both from associated injuries. Nonopera tive management was successful in 51 (98%) of the remaining 52 patients. No follow-up abdominal CT scans were performed on 21 (40%) patients; none dev eloped hepatic complications. An initial follow-up CT scan was obtained in 31 (60%) patients. Information from these scans directly affected managemen t in 3 (9%) patients; in each case, the scans were prompted by a change in clinical status. One significant biloma with bile leak was managed by nasob iliary stenting and percutaneous drainage. One hepatic artery-to-portal vei n fistula was obliterated by transarterial embolization. A single missed di aphragm rupture necessitated laparotomy. Additional late follow-up CT scans were obtained in 13 patients; no clinically useful information was evident on any of these examinations. We conclude that follow-up abdominal CT scan s are not routinely necessary in patients with liver injuries treated nonop eratively. Selective criteria based on the severity of liver injury, presen ce of associated intra-abdominal pathology, and clinical parameters should dictate the need for follow-up imaging studies.