NON-OPERATIVE MANAGEMENT OF BLUNT HEPATIC TRAUMA: RESULTS OF A PROSPECTIVE TRIAL
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Background: It has been shown that bleeding from injured Liver can cease spontaneously, in the majority of blunt hepatic trauma. The aim of the study was to evaluate the criteria of non-operative management for patients with blunt hepatic injury. Study design: Thirty five patients with blunt hepatic trauma were selected for non-operative management from January 2003 to October 2005. All patients were hemodynamically stable and admitted to the Intensive Care Unit (ICU) for the first 24-72 hours. They were subjected to resuscitation, close observation. serial Laboratory investigations and scanning assessment. Results: Thirty five patients with liver injuries were classified according to CT findings into grade I in 2 patients (6%), grade II in 11 patients (31%), grade III in 12 patients (34%) and grade Win 10 patients (29%). CT scan revealed minor hemoperitonewn in 8 patients (22.8%), moderate hemoperitoneum in 10 patients (28.6%) and major hemoperitoneum in 10 patients (28.6%). Liver enzymes ALT and AST levels at admission were significantly correlated to the grade of the hepatic injury. Non-operative management succeeded in 28 patients (80%) of patients with blunt hepatic trauma while 3 patients (8.6%) required laparotomy after initial success of non-operative management Percutaneous guided drainage was required for 4 patients (11.4%) with localized collection. The mortality rate was 2.8%.