A CLINICAL STUDY ON BLUNT HEPATIC INJURY

Abstract

Twenty-three cases with blunt hepatic injury (type Ia: 1 case, Ib: 8, II: 5, IIIa: 4 and IIIb: 5) experienced at the hospital for the past 9 years were clinically analyzed to elucidate the diagnosis, therapeutic course and operative procedure for hepatic injury. For the diagnosis of hepatic injury, value of GPT reflected the extent of hepatic injury. Especially, over 500 IU/l elevation was found on most cases of type III. Roentogenologically, only hepatic injury and bleeding around there was recognized on type II, but massive bleeding and lacerations reached to the surface of the liver were recognized on most cases of type III. These findings are effective on preoperative indexes of degree of hepatic injury or classification, and criteria of indication of laparotomy. For the therapeutic course, conservative treatment is possible to the cases on which vital sign is stable, without muscular defense. But laparotomy is necessary to the cases on which muscular defense or shock state is recognized. At that time, operative procedure on type II or III is inhibition of bleeding at the portion of the hepatic injury as a general rule. For the cases on which hepatic resection is necessary, it is thought to put an end to resectional debridement as much as possible.