[Blunt hepatic and splenic trauma: indications for conservative treatment based on computerized tomography]

In this paper the authors try to define CT criteria for the evaluation of hepatic and splenic injuries in blunt abdominal traumas, to suggest and guide the nonoperative management of trauma in hemodynamically stable patients. The predictive value of CT on the outcome of the nonoperative treatment in adult patients with blunt hepatic and splenic trauma is trusted more and more also thanks to the good results of conservative management in similar injuries in pediatric patients. Thus, we reviewed 314 emergency abdominal CT scans performed in our center March 1990 to March 1992. The hepatic and splenic injuries detected on CT scans were evaluated according to a CT-based injury classification in grades, with a score reflecting progressive severity of lesions. Moreover, the presence of intraperitoneal hemorrhage was determined and quantified on the basis of a standard classification system. Of 314 cases, CT revealed blunt hepatic injury in 17 patients and blunt splenic injury in 38. We excluded the patients who exhibited, besides the hepatic or splenic injury, other severe visceral lesions which might need surgery. Nonoperative management was attempted in 9 of 17 patients with hepatic injury and in 4 of 38 patients with splenic injury detected by CT; the scores given according to the above classification system were compared with the clinical outcome. The results indicate that hepatic injuries up to and including grade III, as assessed by CT, can be successfully managed without surgery in hemodynamically stable patients. As for splenic traumas, nonoperative management was attempted in a very small number of patients. Even though a case of grade-III splenic injury in our series was successfully treated without surgery, this may not be the rule, because the outcome of splenic injury and of intraperitoneal hemorrhage is often unpredictable.