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|Title: ||Outcome of nonoperative management of blunl liver trauma|
|Authors: ||Bismar, Hayan A.|
Alam, Mohammed K.
Al-Keely, Mohammed H.
Al Salamah, Saleh M.
Mohammed, Abdulmajeed A.
|Keywords: ||liver trauma|
|Issue Date: ||2004 |
|Citation: ||Saudi Medical Journal: 25 (3); 294-29|
|Abstract: ||Objective: To evaluate our experience with the
management of blunt liver trauma at Riyadh Central
Hospital, Kingdom of Saudi Arabia.
Methods: The hospital records of 68 patients treated
for blunt liver trauma at Riyadh Medical Complex over a
5-year period (1997 through to 2002) were reviewed
retrospectively. Patients who were hemodynamically
unstable or had peritonitis were treated by urgent
laparotomy (operative group). The other group of patients
were treated conservatively as they were
hemodynamically stable (nonoperative group) in the
intensive care unit (ICU). All patients had computed
tomogram of the abdomen with oral and intravenous
contrast. Injuries grades were classified according to
American. Association for the Surgery of Trauma
(AAST). Follow up computed tomogram of the abdomen
was performed in 1 -2 weeks time.
Results: A total of 68 patients were treated over a
5-year period. Thirty-three patients (49%) were treated
by immediate surgery. Hepatorraphy was performed in
22 patients, non anatomical resection in 3 patients and
liver packing in 2 patients to control bleeding. No activ
bleeding was found in 8 patients. Nonoperative grou
(n=35, 51%) were managed in the ICU for clos
monitoring. Surgically treated group had more patient
with complex liver injury (30% versus 11%), requira
more units of blood (3.2 versus 2.1) but had a shorte
hospital stay (9 days versus 12 days). Two patients fo
nonoperated group develop complications (biloma: on
patient, infected hematoma: one patient), th
nonoperative treatment failed in one patient who require'
laparotomy due to rebleeding from grade IV liver injur
with failure rate of 3%. The only mortality (one patienl
was in the operated group.
Conclusion: The nonoperative treatment is a safe an
effective method in the management of hemodynamicall
stable patients with blunt liver trauma. The nonoperativ
treatment should be the treatment of choice in sue
patients whenever computed tomogram and ICU facilitie
are available. However, further studies with large
number of patients are needed to support our results.|
|Appears in Collections:||King Khalid Hospital|
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