[Study of blunt hepatic injury by ultrasonography]

Sixty five consecutive patients with blunt hepatic injury were evaluated retrospectively to assess the clinical usefulness of emergency ultrasonography (US). In 30 patients before introduction of US, five patients (16.7%) were treated nonoperatively since they were hemodynamically stable with negative paracentesis. Another four hemodynamically stable patients were surgically treated due to positive paracentesis. After introduction of US, on the other hand, 17 out of 35 patients (48%) were successfully managed nonoperatively. Furthermore, US revealed small intraperitoneal bleeding and enabled conservative treatment of four hemodynamically unstable patients. There was no change in the management of central liver rupture or Makiya's type III injury. The number of nonoperatively managed cases of Makiya's types I and II increased from 1 to 7 after using US, and that of operative cases decreased from 21 to 12. Thus US was helpful to exactly assess the amount of intraperitoneal bleeding and successfully reduce the number of unnecessary laparotomy. We conclude that US provides useful information to decide early management of blunt hepatic injury.