Non-operative treatment for blunt liver trauma. Clinical experiences and analysis

Among abdominal injuries, liver is one of the most easily traumatized organs. In the recent ten years, non-operation has been employed as an alternative method for treatment of selected liver trauma patients, as opposed to surgical procedures. In the recent 2 years, 135 patients with liver trauma have been treated. Among them, 25 patients first received non-operative treatment. This particular group met the criteria set out here for the nonoperative method. Under close observation in the ICU, 20 were successfully treated, 4 failed, and the remaining 1 died from other serious (head) injuries. The four failed cases, all showed unfavorable vital signs, namely persistent decreasing hemoglobin, growing rebound pain or sepsis. Given these circumstances, exploratory laparotomy was performed, but two failed because of persistent bleeding, one of suspected other intraabdominal injuries and the other had an intraabdominal abscess. In considering predictive factors causing unsuccessful outcome, total volume of blood transfusion (more than 1000cc) and a higher level of GOT may foretell the effectiveness of this particular method. Nevertheless, further supporting evidence is needed. CT scan, a good way to detect liver trauma, usually underestimates the severity of liver injury to some degree. Two such instances were among the four failed cases, where the full extent of liver injuries was understated. Thus, when analyzing data collected from CT scan, close scrutiny of this masking effect is essential, lest unnecessary therapeutic difficulties ensue.