Blunt liver trauma: selective conservative approach

Abstract

Objective: to highlight the scope of conservatism in the selective blunt liver injuries in patients who are hemodynamically stable. Study design: prospective non-interventional descriptive study. Place and duration of study: the study was conducted in Surgical Unit-I and IV of Allied and DHQ Hospitals, PMC, Faisalabad, during three years from August 2004 to august 2007. Patients and Methods: out of 45 patients received during this period, 28 were hemodynamically unstable and were immediately explored, the remaining 17 were enrolled in the study who were managed conservatively. After resuscitation all the patients underwent Ultrasound and then followed up with serial Hb% estimation and repeat ultrasound scanning in the High Dependency Unit of the wards. The patients were discharged on 7^th day, if the hematology and check Ultrasound scan was normal with the advice to restrict physical activity and the regular follow-up in the OPD. Results: out of the 17 patients treated conservatively, 14 were male and only 3 were females.the SGPT levels were elevated in 84%. More than one liter of hemoperitoneum was detected in two cases who were given 4 units of blood and 11 of the 17 patients needed blood transfusion.. there was no missed intraabdominal injury in our series. The mean length of hospital stay was 10.2 days. The two patients(11.76%)developed perihepatic abscess and were treated by subcutaneous drainage. Conclusion: Selective non-operative approach is a valid policy for patients with blunt liver trauma who are hemodynamically stable.