title: Selection criteria for non-surgical treatment of liver injury in adult polytraumatized patients.
abstract: Conservative treatment of hepatic trauma is currently implemented in 80-90% of cases with a success rate of 92.5% and is mainly based on the haemodynamic status of the patients. We conducted a retrospective study of 71 patients with hepatic trauma from January 1993 to April 2001 and reviewed our experience with surgical and conservative treatment, also considering associated extrahepatic lesions. Fifty-three (74.6%) patients with liver trauma underwent celiotomy and 18 (25.3%) were treated conservatively. Haemodynamic instability was the most common indication for surgery (34 patients). Eighteen (52.9%) patients required an extrahepatic surgical procedure. Nineteen (35.8%) patients were haemodynamically stable and the indications for surgery in these cases were penetrating trauma in 6, large haemoperitoneum in 12, and diaphragmatic rupture in 1. The overall mortality in the operated group was 15%, but the liver-related mortality rate was 7.5%. The success rate for conservative management was 88.8%, with mortality 0% and morbidity 11%. The patients managed conservatively had grades of injury (I-III) similar to the haemodynamically stable operated patients (94.4% vs 94.7%), whereas the haemoperitoneum was larger in the operated group (63.1% vs 11.1%). Non-operative management is the preferred treatment option in haemodynamically stable patients with limited haemoperitoneum, regardless of the grade of the hepatic lesion, and without severe intra-abdominal injuries.
authors.affiliation: 4a Divisione di Chirurgia Generale, Ospedale Ca' Foncello, 31100 Treviso.
authors.forename: Luca
authors.initials: L
authors.lastname: Bonariol
authors.forename: Marco
authors.initials: M
authors.lastname: Massani
authors.forename: Ezio
authors.initials: E
authors.lastname: Caratozzolo
authors.forename: Alfonso
authors.initials: A
authors.lastname: Recordare
authors.forename: Paolo
authors.initials: P
authors.lastname: Callegari
authors.forename: Michele
authors.initials: M
authors.lastname: Antoniutti
authors.forename: Francesco
authors.initials: F
authors.lastname: Calia di Pinto
authors.forename: Franca
authors.initials: F
authors.lastname: Callegari
authors.forename: Alessandro
authors.initials: A
authors.lastname: Jelmoni
authors.forename: Nicolò
authors.initials: N
authors.lastname: Bassi
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003964:Diaphragm / Q000293:injuries; D005260:Female; D006439:Hemodynamics; D006465:Hemoperitoneum / Q000601:surgery; D006801:Humans; D008099:Liver / Q000293:injuries*; D008297:Male; D008875:Middle Aged; D009104:Multiple Trauma / Q000209:etiology / Q000628:therapy*; D018579:Patient Selection; D012189:Retrospective Studies; D012421:Rupture; D014949:Wounds, Nonpenetrating / Q000209:etiology / Q000628:therapy*; D014950:Wounds, Penetrating / Q000601:surgery