The fate of unruptured intrahepatic hematomas.
In 4 year's experience, we admitted 283 patients suffering from severe blunt torso trauma. Sixty-five had serious hepatic injury. Of these, 49 (75.4%) had explosive hemorrhagic hepatic injuries and underwent surgery immediately. The remaining 16 (24.6%) had intrahepatic hematomas (IHHs); three were receiving anticoagulants. Fourteen IHHs were diagnosed by liver-spleen scan within 1 to 3 days after injury, one was diagnosed at autopsy and one during surgery. Nine (56.3%) were successfully treated nonoperatively. Six (37.5%) were initially treated nonoperatively, but required emergency surgery later because of life-threatening complications. The onset of complications occurred from 1 to 28 days after injury. Indications for delayed operative intervention were hepatic abscess with sepsis (four patients) and expanding hematoma and blood loss (two patients). We conclude from this experience that: (1) Patients admitted with blunt torso trauma should undergo liver-spleen scan examinations; (2) IHHs should be treated initially nonoperatively; (3) the observation period for nonoperative management should be at least 28 days; (4) serious sequela of IHHS occur approximately 1 to 28 days after injury; (5) the combination of anticoagulation and IHH is highly lethal and must be treated aggressively; and (6) patient with progressive findings--worsening sepsis, increasing peritoneal findings, evidence of progressive blood loss, or expansion of IHHs--should be treated by urgent surgical intervention.
D000293:Adolescent; D000328:Adult; D000368:Aged; D000925:Anticoagulants / Q000009:adverse effects / Q000627:therapeutic use; D002648:Child; D005260:Female; D006406:Hematoma / Q000150:complications* / Q000209:etiology / Q000628:therapy; D006465:Hemoperitoneum / Q000209:etiology; D006801:Humans; D007223:Infant; D008099:Liver / Q000293:injuries*; D008100:Liver Abscess / Q000209:etiology; D008107:Liver Diseases / Q000150:complications* / Q000209:etiology / Q000628:therapy; D008297:Male; D008875:Middle Aged; D012421:Rupture; D013997:Time Factors
D000925:Anticoagulants