Conservative treatment of traumatic closed hepatic haematoma

A retrospective review was performed of nine patients with closed hepatic haematoma admitted to the Department of Surgery, Auckland Hospital, between 1980 and 1985. All resulted from blunt abdominal trauma due to motor vehicle accidents. Four haematomas were diagnosed at the time of laparotomy and were left undisturbed; four haematomas were diagnosed radiologically were also treated conservatively. One patient underwent partial right hepatic lobectomy, required a significant blood transfusion and developed a subphrenic abscess postoperatively. A further patient died from associated head injuries. The peri-operative mortality for urgent hepatic resection in multiply-traumatized patients is greater than 50%, even in experienced trauma units, and this review suggests that in haemodynamically stable patients with closed hepatic haematomas where the diagnosis can be radiologically ascertained, conservative treatment is a safe and reasonable option.