Nonoperative Management and Follow-up of Hepatic and Splenic Injuries after Blunt Trauma

Lee, Keun Ho; Hong, Min Kwang; Oh, Se Jeong; Park, Seung Man; Kim, Young Ha; Sohn, Kyung Myung

Abstract

PURPOSE: This study evaluates the effectiveness of nonoperative management of blunt hepatic and splenic injuries and the efficiency of follow-up.
METHODS
The medical records of 49 patients with blunt hepatic and splenic injuries from January 1, 1993, to November 30, 1999, were reviewed. There were 35 patients with hepatic injuries and 14 patients with splenic injuries. The patients were divided into two groups, early and late, according to the year of injury. The severities of the injuries were determined by using the organ injury scale (OIS). We analyzed radiological findings and clinical parameters, including the cause of injury, combined injuries, symptoms, vital signs, amount of transfusion, reason for operation, operative findings, length of hospital stay, and complications. The results of treatment and follow-up were evaluated.
RESULTS
Of the 49 patients, 34 patients (69.4%) were treated nonoperatively. There were no mortalities and treatment failures in patients with nonoperative treatment. Indications of operation during nonoperative treatment were hemodynamic instability and signs of aggravated peritoneal irritation. Major hepatic venous injury was suggestive of hemodynamic instability. There was a significant difference between patients with nonoperative management and those with operative management in transfusion requirements (1.2 units vs. 12.1 units, p<0.05). The rate of nonoperative management increased from 50.0% (12/24) in the early group to 88.0% (22/25) in the late group, and nontherapeutic operation decreased from 16.7% (2/12) in the early group to 0% (0/3) in the late group. All 34 patients with nonoperative management took CT scans as a follow-up. In patients with grade I or II on the OIS, the lesions had nearly disappeared at 2 weeks after injury. However, in patients with grade III or higher, resolusion of the lesion was minimal. A hepatic cyst developed in one patient with grade IV and a splenic cyst developed in another.
CONCLUSION
Hemodynamic stability and findings on serial physical examinations are significant criteria for nonoperative management of blunt hepatic and splenic injuries. In patients with grade I or II injuries on the OIS, a follow-up CT is not necessary. In patients with grade III or higher, it is more efficient to delay a follow-up CT until 3 weeks or later after the injury if there are no symptom suggesting complications.