Although well accepted in pediatric patients, non-operative management of blunt hepatic trauma in adults remains controversial. In addition, the ideal patient selection criteria for nonoperative management are still undefined. To investigate the
trend
of treatment modality for adults with blunt hepatic injury and to suggest the possible criteria for nonoperative management, we reviewed 46 adult patients with blunt hepatic injury who were identified with blunt hepatic injury that been confirmed
by
abdominal exploration or abdominal CT in chungang Gil Hospital from September 1989 to August 1993. Of 46 patients, 12 were treated with honoperative management.
1) The peak incidence of age was the 3rd decade (15, 32.6%) and the male to female ratio was 2.5:1.
2) The most frequent injury mechanism traffic accident (31, 67.4%)
3) The most frequently used as a diagnostic modality was abdominal CT (10, 83.3%) in nonoperative groupo, symptom and paracentesis (19, 55.9%) in operative group.
4) With using Liver Injury Scale of American Association for the surgery of trauma (AAST), 2 were Grade I, 9 Grade II, 1 Grade IV in nonoperative groupo and 7 were Grade I, 11 Grade II, 9 Grade III, 7 Grade IV in operative group.
5) Between nonoperative group and operative group, there were significant difference in Systolic blood pressure, APACHE II Score, Injury Severity Score, Glasgow Coma Scale, GOT, GPT, Albumin and transfusion amount, also in Hospitalization and
Time
in
ICU, excluding the patients who died despite operative treatment. In Patients with Grade II, there were significant difference in Systolic blood pressure, Injury Severity Score, GOT, transfusion amont and Time in ICU (p<0.05).
6) The mean number of associated organ injury was 1.3 eases in nonoperative group, 2.1 cases in operative group and the cases without associated organ injury were 4 in nonoperative group and 3 in operative egroup.
7) In review of abdominal CT findings in nonoperative group, 9 cases were hematoma, 3 cases laceration in nature, 10 cases were right lobe, 2 cases left lobe in location and all were below the 500 cc in intraperitoneal blood.
8) No complications and death were noted during an average follow-up of 5 weeks.
We conclude that nonoperative management of blunt hepatic injury in adults based on abominal CT findings is a useful alternative in a select group of hemodynamically stable patients.
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