Selective nonoperative management of blunt liver injury using computed tomography
A. A. Meyer, R. A. Crass, R. C. Lim Jr, R. B. Jeffrey, M. P. Federle and D. D. Trunkey
Computed tomographic (CT) scans are used to evaluate victims of blunt
trauma for abdominal injury when reasons for immediate laparotomy are not
present. Twenty-four patients whose CT scans showed liver injuries that
were small parenchymal lacerations or intrahepatic hematomas were managed
without laparotomy. Intra-abdominal blood was absent or estimated to be
less than 250 mL in volume. None of the patients were in shock; six
patients required transfusions, none for acute abdominal bleeding. None of
these patients subsequently required laparotomy or showed hepatobiliary
problems at a follow-up examination less than one year later. Five
follow-up scans showed varying degrees of resolution. Two patients died of
severe head injury, but the liver injury did not contribute to the cause of
death. Other patients with more severe blunt liver injury who were treated
nonoperatively developed significant complications that required delayed
surgery. It seems that patients with limited liver injury diagnosed by CT
scan and selected by strictly applied criteria can be managed safely
without laparotomy in a setting where rapid evaluation and treatment of any
potential complication is available.
