Blunt hepatic trauma. Nonoperative management in adults
J. A. Federico, W. R. Horner, D. E. Clark and R. J. Isler
Department of Surgery, Maine Medical Center, Portland 04102.
Fifty-six adults were identified with blunt hepatic trauma. Sixteen
patients (29%) were treated successfully with nonoperative management.
There were no delayed laparotomies or deaths in the nonoperative group. All
patients required close observation. Eight (50%) of 16 patients required
transfusion of no more than 3 U of packed red blood cells. There were two
significant late complications requiring readmission. Four (25%) of 16
patients had complex fractures, yet were treated successfully without
laparotomy. The quantity of fluid in the abdomen, as estimated by computed
tomography, did not predict failure of treatment. Nonoperative management
of blunt hepatic injuries is a useful alternative in selected patients when
the course of therapy is based on the hemodynamic stability of the patient
and supported by computed tomographic findings.
