[Contusions of the liver in adults. Initial non-operative management with computerized tomography follow-up is a reasonable therapeutic option. Report of 16 cases].
Nonoperative management of blunt liver injury in adults still remains controversial. From February 1985 through September 1989, 27 patients were treated for blunt hepatic trauma: 11 required immediate operation and 16 (59%) were initially managed nonoperatively after evaluation of intraabdominal injury by computerized tomography. All of these 16 patients were hemodynamically stable and had no significant peritoneal signs. CT criteria for nonoperative management included subcapsular and intrahepatic hematoma, capsular tear or unilobar fracture, absence of large hemoperitoneum, absence of large devitalized liver and absence of other intraabdominal organ injuries. Clinical follow-up, repeated radiologic examinations and surgery confirmed the accuracy of CT. Only 2 patients required delayed operation (12.5%). Serial abdominal CT studies are an integral part of the conservative treatment of blunt hepatic injuries and showed complete resolution of hepatic injuries in the fourteen nonoperated patients in less than six months. No death and no delayed septic or biliary complications were noted. Mean hospital stay was seventeen days for all of the patients (multiple injuries or not) and only ten days for isolated blunt liver injury. These good results depend on identification of candidates for nonoperative management on strict clinical and CT criteria. Nonoperative management of adult blunt liver injury based on these findings is a useful alternative in a selected group of hemodynamically stable patients and decreases the rate of non-therapeutic coeliotomy.
Delaby
J
J
Service de Chirurgie Viscérale, CHRU, Angers.
Bouin
E
E
Casa
C
C
Coppo
B
B
Deen
M
M
Ronceray
J
J
Plane
P
P
D000328:Adult; D003288:Contusions / Q000000981:diagnostic imaging* / Q000601:surgery; D005260:Female; D005500:Follow-Up Studies; D006439:Hemodynamics; D006801:Humans; D008099:Liver / Q000293:injuries*; D008107:Liver Diseases / Q000000981:diagnostic imaging* / Q000601:surgery; D008297:Male; D014057:Tomography, X-Ray Computed; D014463:Ultrasonography
Contusions du foie de l'adulte. L'abstention opératoire initiale sous contrôle tomodensitométrique est une option thérapeutique raisonnable. A propos de seize observations.