1992 Volume 53 Issue 11 Pages 2610-2614
We reviewed the indication for surgery in patients with blunt liver trauma. Patients were divided into two groups: Group A, in which emergent surgery was performed and Group B, in which initial therapy was conservative. In Group A, the blood pressure upon arrival at our hospital was 90±29 mmHg (mean±S. D.), versus 117±21 mmHg in Group B. The blood pressure after rapid fluid infusion was 98±22 mmHg in Group A and 117±15 mmHg in Group B. Peritoneal signs were elicited in 61% of patients in Group A and 15% of those in Group B. This difference was significant. Free fluid within the peritoneal cavity was observed ultrasonography in all patients in Group A in whom the examination was performed, but in only 15% of patients in Group B. Ultrasonographic signs of intrahepatic hematoma and hepatic rupture were found in 25% and 19% in Group A and 32% and 5% of patients in Group B, respectively. As to multiple trauma, there was no significant difference in the incidence of associated rib fracture, pulmonary contusion, or hemo/pneumothorax between both groups. A predominant concomitant injury to the spleen or pancreas was observed in group A compared to the other. Patients with blunt trauma may have concomitant intra-abdominal injury even when the degree of liver injury is not severe. Patients with hypotension unresponsive to fluid challenge, peritoneal signs, and a large, or expanding, intra-abdominal fluid collection may require laparotomy to control bleeding.
