Nonoperative management of major blunt liver injury with hemoperitoneum
J. R. Hiatt, H. D. Harrier, B. V. Koenig and K. J. Ransom
Trauma and Emergency Surgery Service, UCLA Medical Center 90024.
We evaluated the role of nonoperative therapy in 16 patients with blunt
multisystem trauma, hemodynamic stability following resuscitation, and
major lobar liver injury; the patients were treated with a protocol of
intensive care unit observation and computed tomographic scanning to
identify and follow up the hepatic lesion. Computed tomographic scans
showed right-lobe or bilobar liver lacerations and/or subcapsular hematomas
in all patients and associated hemoperitoneum in 8 patients. Exploration
was required in 2 patients; both were found to have a hemoperitoneum and a
nonbleeding liver laceration. There were no deaths. Patients with
hemoperitoneum requiring transfusion had significantly greater injury
severity scores and longer intensive care unit and hospital stays. The
major advantage of a nonoperative approach is the opportunity to stabilize
major extra-abdominal (particularly head) injuries as the first priority.
Unstable hemodynamics, abdominal distension, and falling hematocrit are
indications for prompt exploration. Nonoperative care of these injuries
requires a strict treatment protocol.
