with increasing the use of computerized tomogram(CT) as a diagnostic modality in blunt abdominal trauma, discovery rate of hepatic injury and frequency of non-operative management have increased in adults as well as in children. The principles
for
non-operative management for hepatic injury are 1) the patients should be hemodynamically stable, and 2) there should be no evidence of other intraabdominal organ injuries. But there were still no specific guidelines for non-operative management
in
regard to the injury severity, amount of intraperitoneal blood, and transfusion amount. To investigate trend of treatment modality in blunt hepatic injury and to suggest the possible guideline for non-operative management, we reviewed 86
consecutive
patients with blunt hepatic injury in Severance Hospital and Yongdong Severance Hospital from January, 1989 to June, 1993. The mean age was 32.5 with a range from 3 to 84 and 67.4% were male. The most frequent injury mechanism was traffic
accident(66.3%). Sixty three (73.3%) have more than one combined injuries and 24 were associated with another intraabdominal injuries. CT was most frequently used as a diagnostic modality(57, 66.3%). Forty two (48.8%) was treated non-operatively
and
only 28(33.7%) were needed surgical procedure to the hepatic injuries. Among the other 16, 4 had negative laparotomy and 12 had one or more definitive operations elsewhere. With using Jnjury Severity Scale of American Association for the Surgery
of
Trauma(AAST), 33 were Grade I, 23, Grade II, 20 Grade III, 7 Grade IV, and 3 Grade V. In non-operative group, 17 were Grade II, 12 Grade III, and one Grade IV We noticed that 11 of 12 Grade III non-operative patients had intrahepatic hematoma
more
than
2cm in diameter and only one case had deep laceration more than 3cm. Eleven of 42 non-operative group had history of shock, which had been easily corrected by resuscitation. There was no difference in transfusion amount between non-operative
group(n=10,
2.8±1.4U) and operative group(n=12, preoperative, 1.5±1.4U), excluding the patients with combined injuries. Time interval from injury to arrival is longer in non-operative group(14.1 hour) than operative group (3.3 hour). Among 21 who were
arrived
more than 12 hours after injury, only two cases were needed operations, moreover those were 13 hours. We conclude that non-operative management in blunt hepatic trauma could be considered in most stable patient without evidence of other
intraabdominal
injuries, regardless of history of shock and transfusion amount. To use the AAST grading system in hepatic trauma for the guideline of non-operative management, intrahepatic hematoma in Grade III should be corrected to Grade II.
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