Conservative Management of Blunt Hepatic Trauma for Patients with High Severity Grades Injuries A Clinical Selective Prospective Study
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- Category: Vol. 84, June 2016
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Conservative Management of Blunt Hepatic Trauma for Patients with High Severity Grades Injuries A Clinical Selective Prospective Study, YEHIA G. ABO SAYED
Abstract
Design: This study was designed to evaluate the role of conservative treatment of blunt hepatic trauma to investigate the possibility of expanding its indications for high severity grades liver injuries.
Background: The treatment of complex liver injuries remains a challenge. Non operative treatment for such injuries is increasingly being adopted as the initial management strategy. We reviewed our experience, at Shebin El-Kom Teaching in the non operative management of high severity grades liver injuries with the intent to evaluate failure rates; and in-hospital mortality and complications.
Methods: This study was conducted in Department of General Surgery in Shebin El-Kom Teaching Hospital from October 2013 to October 2015. All patients admitted to the hospital with blunt abdominal trauma and diagnosed as liver injuries that fulfilled the selected criteria for conservative treatment were the candidates of this study. All cases were treated conservatively by resuscitation and closed ICU mon-itoring. Failure of conservative treatment depends on failure criteria designed in the study. The patients records were reviewed to determine the general condition of the patient, CT findings regarding the site and extent liver injury, necessity to blood transfusion, complications related to the conservative treatment and necessity to adjunctive treatment, and mortality.
Results: Over 24 months, 54 patients with blunt hepatic trauma that fulfilled the selected criteria were the candidates of this study. Twenty nine liver injuries (53.7%) were of low severity (grades I and II), while 25 (46.3%) were of high severity (grades III and IV). All cases of low severity were treated conservatively without complication. Of the 25 cases with high severity; one case (1.9%) was explored for hemo-dynamic instability and one case (1.9%) developed haemobilia and needed adjunctive treatment in form of selective angiog-raphy to close the bleeding source. No mortality was recorded in our study.
Recommendation: In our experience, non operative man-agement of high grade liver injury for stable blunt trauma patients is associated with high success rates without significant complications.