Several significant advances in the treatment of liver injuries have been evolved over the past decade. Nonoperative treatment is one of the recent changes in the management of blunt liver injury.
23 cases of liver injury caused by blunt abdominal trauma during 1991~1994 are reviewed. Our criteria for nonoperative treatment were: ①hemodynamic stability, ②no evidence of associated intraabdominal organ njury, ③absence of coagulopathy and
④alert
mental status. By these criteria, the feasibility of nonoperative treatment was tested in association with injury grade, level of liver enzyme and the age gorup.
Serum aminotransferase was checked at admission and 2 weeks and 4 weeks after admission. Initial diagnosis and follow-up check had been made by computerized tomograhic scan at admission and 2 weeks 4 weeks and 6 weeks after admission.
At admission, all patients had shown high serum aminotransferase which were normalized after 2~3 weeks. Lacerated adges disappeared after 2 weeks in children and 4~6 weeks in adult on the follow-up CT scan. Nonopertive treatment was successful in
all
patient except 1 case. The failed case was explerated at 5th. Admission day due to bile peritonitis. These result suggest that nonoperative treatment is a safe method for the blunt liver injuries which have hemodynamic stability, no evidence of
associated intraabdominal organ injury, absence of coagulopathy and alert mental stauts. All patient had demonstrated high serum aminotransferase but there was no association between injury grade and liver enzyme(AST: P value=0.673, ALT: P
value=0.591).
the lesions of children were disappeared on 2 week follow-up CT scan but in 7 among 12 adults lesion were clearly visible on 2 week follow-up CT scan (P value=0.021). There was difference between adult and child in healing speed.
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