Management of Blunt Hepatic Injury and Splenic Injury

: The Role of Surgery and IVR

Abstract

To assess the appropriate management of blunt liver injury and splenic injury, we retrospectively reviewed 29 patients with blunt hepatic injury and 18 patients with splenic injury who were admitted to our university hospital. According to the classification of the Japanese Association for the Surgery of Trauma, the patients with hepatic injury were divided into types Ia (1), Ib (6), II (3), IIIa (4) and IIIb (13) and the patients with splenic injury were divided into types Ia (1), II (4), IIIa (5), IIIb (2), IIIc (4) and IIId (1). Eight patients with hepatic injury (type IIIa and IIIb) were successfully treated with TAE (transcatheter arterial embolization). Ten patients with hepatic injury (type IIIa and IIIb) underwent laparotomy, 1 of whom required damage control surgery at first. TAE was performed in patients with types II and III splenic injury. Twelve patients with type III splenic injury required laparotomy, 1 underwent splenorrhaphy, 2 underwent partial splenectomy and 10 underwent splenectomy. In the initial treatment for hepatic injury and splenic injury, the control of bleeding from the liver or spleen and hemodynamic stabilization were most important. Operative or non-operative management should be selected based on hemodynamic stabilization, the extent of injury to the liver or spleen and the presence of injury to any other organ.