Blunt hepatic trauma. Nonoperative management in adults

Fifty-six adults were identified with blunt hepatic trauma. Sixteen patients (29%) were treated successfully with nonoperative management. There were no delayed laparotomies or deaths in the nonoperative group. All patients required close observation. Eight (50%) of 16 patients required transfusion of no more than 3 U of packed red blood cells. There were two significant late complications requiring readmission. Four (25%) of 16 patients had complex fractures, yet were treated successfully without laparotomy. The quantity of fluid in the abdomen, as estimated by computed tomography, did not predict failure of treatment. Nonoperative management of blunt hepatic injuries is a useful alternative in selected patients when the course of therapy is based on the hemodynamic stability of the patient and supported by computed tomographic findings.