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Selective Nonoperative Management of Blunt Liver Injury Using Computed Tomography

Selective Nonoperative Management of Blunt Liver Injury Using Computed Tomography Abstract • 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. (Arch Surg 1985;120:550-554) References 1. Moon KL, Federle MP: Computed tomography in hepatic trauma . AJR 1983;141:309-314.Crossref 2. Federle MP, Jeffrey RB: Hemoperitoneum studied by computed tomography . Radiology 1983;148:187-192.Crossref 3. Richie JP, Fonkalsrud DW: Subcapsular hematoma of the liver . Arch Surg 1972;104:781-788.Crossref 4. Athey GW: Hepatic hematoma following blunt injury: Nonoperative management . Injury 1982;13:302-306.Crossref 5. Geis WP, Schulz KA, Giacchino JL, et al: The fate of unruptured intrahepatic hematoma . Surgery 1981;90:689-697. 6. Federle MP: Computed tomography of blunt abdominal trauma . Radiol Clin North Am 1983;21:461-475. 7. Lim RC Jr: Injuries to the liver and extrahepatic ducts in trauma management , in Blaisdell FW, Trunkey DD (eds): Trauma Management . New York, Thieme-Stratton Inc, 1982, vol 1. 8. Trunkey DD, Shires GT, McClelland RN: Management of liver trauma in 811 consecutive patients . Ann Surg 1974;179:722-728.Crossref 9. Thal ER, McClelland RN, Shires GT: Abdominal trauma , in Shires GT (ed): Care of the Trauma Patient . New York, McGraw-Hill Book Co, 1979. 10. Madding GF, Kennedy PA: Trauma to the liver , in Dunphy JE (ed): Major Problems in Clinical Surgery . Philadelphia, WB Saunders Co, 1971, vol 2. 11. Olsen WR: Late complications of central liver injuries . Surgery 1982;92:733-743. 12. Sugimoto T, Yoshioka T, Sawada Y, et al: Post-traumatic cysts of the liver found on CT scan: A new concept . J Trauma 1982;22:797-800.Crossref http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png Archives of Surgery American Medical Association

Selective Nonoperative Management of Blunt Liver Injury Using Computed Tomography

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References (16)

Publisher
American Medical Association
Copyright
Copyright © 1985 American Medical Association. All Rights Reserved.
ISSN
0004-0010
eISSN
1538-3644
DOI
10.1001/archsurg.1985.01390290032005
Publisher site
See Article on Publisher Site

Abstract

Abstract • 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. (Arch Surg 1985;120:550-554) References 1. Moon KL, Federle MP: Computed tomography in hepatic trauma . AJR 1983;141:309-314.Crossref 2. Federle MP, Jeffrey RB: Hemoperitoneum studied by computed tomography . Radiology 1983;148:187-192.Crossref 3. Richie JP, Fonkalsrud DW: Subcapsular hematoma of the liver . Arch Surg 1972;104:781-788.Crossref 4. Athey GW: Hepatic hematoma following blunt injury: Nonoperative management . Injury 1982;13:302-306.Crossref 5. Geis WP, Schulz KA, Giacchino JL, et al: The fate of unruptured intrahepatic hematoma . Surgery 1981;90:689-697. 6. Federle MP: Computed tomography of blunt abdominal trauma . Radiol Clin North Am 1983;21:461-475. 7. Lim RC Jr: Injuries to the liver and extrahepatic ducts in trauma management , in Blaisdell FW, Trunkey DD (eds): Trauma Management . New York, Thieme-Stratton Inc, 1982, vol 1. 8. Trunkey DD, Shires GT, McClelland RN: Management of liver trauma in 811 consecutive patients . Ann Surg 1974;179:722-728.Crossref 9. Thal ER, McClelland RN, Shires GT: Abdominal trauma , in Shires GT (ed): Care of the Trauma Patient . New York, McGraw-Hill Book Co, 1979. 10. Madding GF, Kennedy PA: Trauma to the liver , in Dunphy JE (ed): Major Problems in Clinical Surgery . Philadelphia, WB Saunders Co, 1971, vol 2. 11. Olsen WR: Late complications of central liver injuries . Surgery 1982;92:733-743. 12. Sugimoto T, Yoshioka T, Sawada Y, et al: Post-traumatic cysts of the liver found on CT scan: A new concept . J Trauma 1982;22:797-800.Crossref

Journal

Archives of Surgery – American Medical Association

Published: May 1, 1985

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