Nonoperative treatment of blunt hepatic injury in children

Between January 1983 and December 1986, 35 Children with blunt hepatic injury were treated in Chang Gung Memorial Hospital. After vigorous resuscitation, 10 Patients required emergency laparotomies: 9 for massive bleeding, and 1 for associated bowel injury. Exploratory surgery was necessary 5 days after the initial resuscitation in one patient due to rebleeding. The remaining 24 patients who responded well to resuscitations were managed nonoperatively. Imaging examinations (ultrasound, radioisotope scan or computerized tomography scan) provided the diagnosis of liver trauma in all. The hospital courses in all cases were uneventful and there were no complications. In every patient follow-up imaging examinations showed complete resolution of the lesions. We conclude that nonoperative management of selected patients with blunt hepatic trauma is reasonable. With the help of serial imaging examinations, this conservative approach is safe and practical.