Blunt hepatic trauma in adults: correlation of CT injury grading with outcome

To correlate injury grading with computed tomography (CT) to treatment outcome.

Forty-eight patients with proved blunt hepatic injuries underwent dynamic CT with contrast material before treatment. The injuries were classified with a five-point CT-based grading system. The CT injury grades and the amount of hemoperitoneum seen on CT scans were compared with the clinical and surgical findings, radiologic follow-up, and outcome.

Hepatic injuries were classified as CT grade 1 in two patients, grade 2 in 15 patients, grade 3 in 21 patients, and grade 4 in 10 patients. Conservative treatment was performed in 38 patients, including 15 patients with grade 3 and 10 patients with grade 4 injuries; 10 of these patients also had major hemoperitoneum (> 500 mL). Conservative treatment was successful in 37 patients but was complicated in two patients by development of an arteriovenous fistula or a biloma and failed in one patient because of delayed hepatic rupture. Exploratory laparotomy was performed in 10 patients but revealed marked active hepatic bleeding in only one patient.

Injury grading with CT may reflect the degree of hepatic parenchymal damage but does not indicate patients in whom complications may develop or surgery is necessary. Monitoring of conservative treatment with CT allows detection of resultant complications.