Liver abscess after non-operative management of blunt liver injury.
BACKGROUND
The non-operative management of blunt liver trauma can be applied in almost 80% of patients with this type of injury, with the advantages of the need for fewer blood transfusions, less intra-abdominal sepsis, and a better survival rate, than with the operative approach. However, liver abscess, as a known complication of the non-operative management of blunt liver trauma, is discussed infrequently. Therefore, we herein review our experience and describe this complication in detail.


METHODS
From 1995 to 2001, 674 patients were admitted to our hospital due to blunt hepatic trauma. Among these patients, 279 underwent laparotomy and the remaining 395 patients were treated non-operatively. Twenty-two patients were identified as having liver abscess, with 16 of them belonging to the operative group, and six to the non-operative group. A retrospective review of these six patients and their characteristics, as well as pathogenesis, diagnosis, and the management of the liver abscesses, was conducted.


RESULTS
These six patients were all male, with a median age of 19.5 years (range 3-24). The median injury severity score was 16.5 (range 9-25); three patients sustained grade-3 hepatic injury, and the other three were grade 4. The main diagnostic tool was abdominal computed tomography, and the abscesses took a median of 6 days (range 1-12) to form and be diagnosed. The abscesses were usually caused by infection from mixed organisms, and an abscess resulting from Clostridium infection developed within 1 day after injury. These abscesses were treated with antibiotics and drainage, and the median length of hospital stay was 26 days (range 8-44), without mortality or long-term morbidity.


CONCLUSIONS
Liver abscess as a complication of the non-operative management of blunt hepatic trauma is a rare entity, with an incidence of 1.5% (6/395). It is usually seen in severe liver injury (grade 3 and above), but all our patients were all treated successfully, with no mortality. However, prolonged hospitalization may be required in this patient group.
Hsieh
Chi-Hsun
CH
Department of Trauma and Emergency Surgery, Chang Gung Memorial Hospital, Chang Gung University, 5, Fu-Hsing Street, Kwei-shan, 333, Taoyuan, Taiwan. cch2839@ms9.hinet.net
Chen
Ray-Jade
RJ
Fang
Jen-Feng
JF
Lin
Being-Chuan
BC
Hsu
Yu-Pao
YP
Kao
Jung-Liang
JL
Kao
Yi-Chin
YC
Yu
Po-Chin
PC
Kang
Shih-Ching
SC
Wang
Yu-Chun
YC
D000007:Abdominal Injuries / Q000150:complications / Q000628:therapy; D000293:Adolescent; D000328:Adult; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D001424:Bacterial Infections / Q000188:drug therapy / Q000209:etiology; D002648:Child; D002675:Child, Preschool; D004322:Drainage / Q000379:methods; D005500:Follow-Up Studies; D006801:Humans; D015994:Incidence; D015601:Injury Severity Score; D007813:Laparotomy / Q000379:methods; D008099:Liver / Q000293:injuries*; D008100:Liver Abscess / Q000209:etiology* / Q000628:therapy*; D008297:Male; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D012494:Sampling Studies; D016896:Treatment Outcome; D014949:Wounds, Nonpenetrating / Q000150:complications* / Q000628:therapy*
D000900:Anti-Bacterial Agents