Nonoperative Management of Blunt Liver Trauma: The Value of Follow-Up Abdominal Computed Tomography Scans

Abstract

Our hypothesis was that follow-up abdominal CT scans are not routinely necessary in patients with blunt liver injury treated nonoperatively. We conducted an 8-year retrospective review of hospital chart and outpatient clinic records. We reviewed all admission and follow-up CT scans. There were 42 adults and 12 children. There were 1 (2%) grade I, 15 (28%) grade II, 28 (52%) grade III, 8 (15%) grade IV, and 2 (4%) grade V liver injuries. Two patients died during the first 24 hours, both from associated injuries. Nonoperative management was successful in 51 (98%) of the remaining 52 patients. No follow-up abdominal CT scans were performed on 21 (40%) patients; none developed hepatic complications. An initial follow-up CT scan was obtained in 31 (60%) patients. Information from these scans directly affected management in 3 (9%) patients; in each case, the scans were prompted by a change in clinical status. One significant biloma with bile leak was managed by nasobiliary stenting and percutaneous drainage. One hepatic artery-to-portal vein fistula was obliterated by transarterial embolization. A single missed diaphragm rupture necessitated laparotomy. Additional late follow-up CT scans were obtained in 13 patients; no clinically useful information was evident on any of these examinations. We conclude that follow-up abdominal CT scans are not routinely necessary in patients with liver injuries treated nonoperatively. Selective criteria based on the severity of liver injury, presence of associated intra-abdominal pathology, and clinical parameters should dictate the need for follow-up imaging studies.