A Comparison of Operative with Nonoperative Management of Traumatic Injuries to the Liver and Spleen

ABSTRACT

BACKGROUND: We analyzed the clinical characteristics of trauma involving the liver and/or the spleen to evaluate the safety of nonoperative management. METHODS: A retrospective study was conducted on 78 cases who were treated with operative (37 cases) and nonoperative (41 cases) management at Wonkwang University Hospital from January 1995 to June 1998. Nonoperative management was done in hemodynamically stable patients. RESULTS: Three cases in the operative group (OG) and 5 cases in the nonoperative group (NOG) were children. Causes of injury were traffic accidents (66.6%), falls (15.4%), penetrating injuries (11.4%), and assaults (6.4%). Associated intraabdominal injuries were renal contusions (42%), pancreatic injuries (18%), mesenteric tearing (12%), diaphragm ruptures (9%). Associated extraabdominal injuries were chest injuries (56.5%), long bone fractures (15.2%), pelvic bone fractures (9.8%), and CNS injuries (8.7%). Mean total blood requirements were 7.0 units in the OG and 1.2 units in the NOG. Complications were 35 cases in the OG (pleural effusion, 6 cases; intraabdominal abscess, 4 cases; pneumonia, 4 cases; biloma, 3 cases) and 15 cases in the NOG (pleural effusion, 5 cases; pneumonia, 5 cases; intraabdominal abscess, 2 cases). Causes of 8 delayed operations were bowel perforations (small bowel 2 cases, and colon, 1 case), bile peritonitis (2 cases), and hemodynamically instability (3 cases). The hospitalization period was 16 days in the OG and 14 days in the NOG. Six patients in the OG died and the causes were multiple organ failures (4 cases), hypovolemic shock (1 case), and ARDS (1 case). No patient died in the delayed operation cases and the NOG, even in major injury cases aquired respiratory distress syndrom. CONCLUSIONS: Nonoperative management of traumatic liver and/or spleen injury is safe and can be tried initially under the conditions of stable hemodynamics, feasible abdominal CT, and feasible immediate operation.