Résumé
Background: It has been shown that bleeding from injured liver cancease spontaneously, in the majority of blunt hepatic trauma. The aim ofthe study was to evaluate the criteria of non-operative management forpatients with blunt hepatic injury
Study design:Thirty five patients with blunt hepatic trauma were selected for non-operative management from January 2003 to October2005. All patients were hemodynamically stable and admitted to the Intensive Care Unit [ICU] for the first 24-72 hours. They were subjected toresuscitation, 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 IV in 10 patients [29%]. CTscan revealed minor hemoperitoneum in 8 patients [22.8%], moderate he-moperitoneum in 10 patients [28.6%] and major hemoperitoneum in 10 patients [28.6%]. Liver enzymes ALT and AST levels at admission weresignificantly correlated to the grade of the hepatic injury. Non-operativemanagement succeeded in 28 patients [80%] of patients with blunt hepatic trauma while 3 patients [8.6%] required laparotomy after initial successof non-operative management. Percutaneous guided drainage was required for 4 patients [11.4%] with localized collection. The mortality ratewas 2.8%
Conclusion: Minimal intervention is the policy of treating blunt hepaticinjuries in hemodynamically stable patients. It requires strict clinical,hemdynamic, and scanning monitoring, in a centre with intensive care facilities and immediate access to the operating room