Management of Blunt Hepatic Trauma

One hundred and twelve consecutive cases with blunt hepatic trauma between January 1, 1965 and December 31, 1988 at the First Dpartment of Surgery, Nagasaki University were reviewed. Fifty-seven patients had minor injuries, 33 moderate injuries and 22 severe injuries. Sixty-five patients (58%) sustained also one of more associated injuries. Out of 43 patients over the last ten years 30 were diagnosed by US or CT. Eighty-eight patients (78.3%) underwent laparotomy ; laparotomy and drainage alone in 13, suture and packs in 57, debridement and minor liver resection in 11 and right lobectomy in 9. The results of treated patients were assessed according to the grading of liver injury and assocated injury. The overall mortality was 13.4% (15 of 112). True liver-related mortality due to hemorrhage was 26.7% (4 of 5), and the other 11 patients who died were due to refractory shock and the development of multiple organ failure (MOF). Twenty-one patients were conservatively managed with only one death, and the other 20 survivors had no complications and healed completely from 6 to 12 months after trauma. Although lobectomy or resectional debridement are advocated as an operative procedure for massive injury, a conservative management for mild or moderate ruptures is still recommended as far as possible