Ugalde LJC, Ferrufino MAL, Martín-Melgarejo OG, Vázquez MJC, Chávez RRC

Language: Spanish
References: 12
Page: 51-55
PDF size: 252.25 Kb.

ABSTRACT

Objective: To describe nonoperative management of a patient with severe blunt hepatic trauma.
Setting: Central Red Cross Hospital, Mexico City (third level health care hospital).
Design: Case description.
Case description: Man of 19 years of age, with blunt abdominal trauma of 7 days of evolution. He was admitted at the emergency ward referring adynamia, hyporexia, nausea without vomiting, and pain in the right hypochondrium. The patient was hemodynamically stable, presenting general malaise, pale and jaundiced skin and mucosa, in normal cardiopulmonary state. Flat abdomen with dermal abrasions at the upper hemiabdomen that was soft and painful at superficial and deep palpation at the right hypochondrium, without signs of peritoneal irritation, normal peristalsis. Paraclinic evaluation indicated severe anemia with alterations in functional hepatic tests. Abdominal CAT revealed grade IV hepatic lesion with ipsilateral renal compression and perisplenic hematoma. Non-surgical treatment was decided, consisting of absolute rest and strict monitoring vital signs and laboratory tests, aside from blood transfusions during his hospital stay. His hemoglobin and hematocrit values increased until discharge date and later on during control follow-up. Tomographic controls were taken on day 4, and on 2, 5, 6 months after hospital admission, showing reduction in the hepatic parenchymal hematoma.
Conclusion: In the last two decades there has been a change in surgical philosophy regarding conservative management of trauma of intraabdominal solid organs. Nowadays, it is feasible to provide nonoperative treatment to selected patients with severe hepatic trauma, who used to be subjected to surgery. The nonoperative treatment of hepatic injuries has proven effective if all the requirements for its application are met and the necessary hospital resources are available for the multidisciplinary management of these patients.

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