Nonoperative management of blunt hepatic trauma in adults.
Publication/Presentation Date
10-1-1988
Abstract
Although well accepted in pediatric patients, nonoperative management of blunt hepatic trauma in adults remains controversial. From January 1981 through May 1987, 66 adults were identified with blunt hepatic trauma that had been confirmed by abdominal exploration or abdominal computed tomography (CT): 46 underwent immediate operation, and 20 were initially managed nonoperatively. Patients were considered for nonoperative management only if they were hemodynamically stable and had no significant peritoneal irritation. CT criteria for nonoperative management included contained subcapsular or intrahepatic hematoma, unilobar fracture, absence of devitalized liver, minimal intraperitoneal blood, and absence of other significant intra-abdominal organ injuries. The predominant CT pattern in the 17 patients successfully managed nonoperatively included unilobar right-lobe fracture or intrahepatic hematoma. A small amount of blood in either gutter or in the pelvis did not portend failure of nonoperative management. No delayed complications were noted during an average follow-up of 27 months. Nonoperative management of blunt hepatic injury based on abdominal CT findings is a useful alternative in a select group of hemodynamically stable patients.
Volume
104
Issue
4
First Page
748
Last Page
756
ISSN
0039-6060
Published In/Presented At
Farnell, M. B., Spencer, M. P., Thompson, E., Williams, H. J., Jr, Mucha, P., Jr, & Ilstrup, D. M. (1988). Nonoperative management of blunt hepatic trauma in adults. Surgery, 104(4), 748–756.
Disciplines
Medicine and Health Sciences
PubMedID
3175870
Department(s)
Department of Surgery
Document Type
Article