Abstract
One hundred-three consecutive patients who had sustained blunt hepatic trauma since 1965 were reviewed. Fifteen patients who were conservatively treated were also clinically analyzed with reference to current diagnostic methods. 1) In the previous series, 58 patients (96.7%) underwent laparotomy, whereas 13 patients (30.2%) were conservatively managed in the recent series. The extent of liver injury was classified into three types according to severity. 2) All patients who were conservatively managed were diagnosed and followed up by US or CT. Patients who had suffered subcapsular rupture and laceration with grade I or II were mainly selected for conservative therapy. 3) One patient with central rupture of grade III died following hepatic failure, while the other 14 patients did well. Follow-up study by CT showed that the intrahepatic hematoma was spontaneously resolved 6 to 12 months after injury. The following indications for conservative management of blunt hepatic trauma might be considered; a) Vital signs stable or stabilized by transfusion. b) No significant injuries associated with intraperitoneal organs. c) Nature and extent of injuries to the liver are subcapsular rupture or lacerations of grade I or II of no active bleeding. In these patients follow-up by US or CT is needed until the hematoma is completely resolved.
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