[Non-surgical aproach in blunt injuries to the liver and spleen]

Non-surgical approach in blunt injuries of the liver and spleen in patients haemodynamically stable, is widely accepted as their therapeutical method of choice. Based on a retrospective analysis, the aim of this study is to assess the injured patients with blunt injuries of the liver and spleen who were treated non-surgically.

75 injured patients with blunt intraabdominal injuries were hospitalized from 2001 to 2003. The spleen injuries were diagnosed in 40 patients, out of which 12 of them suffered from concomittent injuries of other intraabdominal organs, the liver injuries were diagnosed in 37 cases, out of which 24 injuries were isolated. The non-surgical approach was indicated in haemodynamically stable patients with isolated injuries of the spleen and the liver of the ISt-IVth grade with haemoperitoneum up to 300 ml, diagnosed on a spiral CT examination.

47 (63%) patients were urgently operated for intraabdominal injuries, 7 of them (15%) exited within 30 days after the surgery. The non-surgical approach was indicated in 28 (37%) cases. In this group, 19 patients suffered from liver injuries, 7 from spleen injuries and 2 from pancreatic injuries. The severity of the injury was classified as the It degree in 7 patients, as the IInd degree in 7 patients, as the IIIrd degree in 7 patients and as the IVth degree in 5 patients. The non-surgical procedure failed in 5 (19%) cases of patients with IIIrd or IVth degree liver or spleen injuries. The failure was caused by a delayed bleeding from the injured spleen in 3 patients and by a continuous bleeding in the IVth degree liver injury and the bile collection from the biliary bladder rupture in the patient with the IIIrd degree liver injury. The spleen injury was treated using splenectomy. In the IVth degree liver injury a debridement of the dilacerated tissue of the 7th segment and a ligature of the injured branch of the right hepatic vein, were conducted. The patient with the IIIrd degree injury was treated using cholecystectomy with a suture of the liver rupture.

The non-surgical approach to the treatment of the isolated blunt liver and spleen injuries is indicated for the injured patients who are haemodynamicaly stable, with Ist-IVth degree injuries, without or with minor (up to 300 ml) haemoperitoneum and with continuous intensive care. The non- surgical approach to the higher degree blunt liver and spleen injuries has higher treatment failure risk rates.