Nonoperative management of blunt hepatic trauma

Abdominal CT scanning makes nonoperative management of liver injury possible. We reviewed medical records of 56 blunt trauma patients with hepatic injury who received initial abdominal CT scan. We examined: 1) Indications for delayed surgery; 2) Disposition or cause of death; 3) Results of follow up CT scans; 4) Long term complications. Over a 53 month period, 1597 patients were admitted for blunt trauma, of which 76 patients were found to have hepatic injury. Twenty patients presented either clinically unstable or with an acute abdomen and underwent diagnostic peritoneal lavage or immediate laparotomy without a CT scan. Abdominal CT scan was performed on 56 patients, 19 of whom had hepatic injury or associated major abdominal injury and underwent laparotomy. One patient died of cardiac arrhythmias following CT scanning. The remaining 36 patients received initial nonoperative management of their hepatic injury. Three patients in this group underwent delayed abdominal surgery. Two developed an acute abdomen. One had a planned nephrectomy. No patient required surgical treatment of their liver injury at the time of laparotomy. Four deaths occurred in the 36 patients managed nonoperatively, all due to associated extra-abdominal injuries. Nineteen patients had 27 CT scans taken as follow up examination at intervals of 1 to 94 days postinjury. All of the CT scans showed stabilization or improvement of hepatic injury. Three patients who had CT scans taken at 3 months postdischarge were asymptomatic, with radiologic resolution of their hepatic injury. Nineteen patients were followed for an average of 61.8 days (range 7-203 days) after discharge with no complications from liver injury.(ABSTRACT TRUNCATED AT 250 WORDS)