This journal only 2009, Number 1 Cir Gen 2009; 31 (1) Nonoperative management of severe blunt hepatic trauma: the exception to the rule. One-case report Ugalde LJC, Ferrufino MAL, Martín-Melgarejo OG, Vázquez MJC, Chávez RRC Full text How to cite this article Language: Spanish References: 12 Page: 51-55 PDF size: 252.25 Kb. Key words: Liver, trauma, blunt trauma, hepatic trauma. 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. REFERENCES Pachter H, Liang H, Hofstetter S. Traumas de hígado y vías biliares. En: Mattox K, Feliciano D, Moore E (eds). Trauma. 4a. Edición. New York. Ed McGraw-Hill. 2000: 675-726. Rutledge R, Hunt JP, Lentz CW, Fakhry SM, Meyer AA, Baker CC, et al. A statewide, population-based time-series analysis of the increasing frequency of nonoperative management of abdominal solid organ injury. Ann Surg 1995; 222: 311-26. Boone DC, Federle M, Billiar TR, Udekwu AO, Peitzman AB. Evolution of management of major hepatic trauma: identification of patterns of injury. J Trauma 1995; 39: 344-50 Richardson JD, Franklin GA, Lukan JK, Carrillo EH, Spain DA, Miller FB, et al. Evolution in the management of hepatic trauma: a 25-year perspective. Ann Surg 2000; 232: 324-30. Pachter HL, Knudson M, Esrig B, Ross S, Hoyt D, Cogbill T, et al. Status of nonoperative management of blunt hepatic injuries in 1995: A Multicenter experience with 404 Patients. J Trauma 1996; 40: 31-8. Croce MA, Fabian TC, Menke PG, Waddle-Smith L, Minard G, Kudsk KA, et al. Nonoperative management of hepatic trauma is the treatment of choice of hemodynamically stable patient. Results of a prospective trial. Ann Surg 1995; 221: 744-55. Farnell MB, Spencer MP, Thompson E, Williams HJ Jr, Mucha P Jr, Ilstrup DM. Nonoperative management of blunt hepatic trauma in adults. Surgery 1988; 104: 748-56. Malhotra AK, Fabian TC, Croce MA, Gabin TJ, Kudsk KA, Minard G, et al. Blunt hepatic injury: a paradigm shift from operative to nonoperative management in the 1990s. Ann Surg 2002; 231: 804-813. Matsubara TK, Fong HM, Burns CM. Computed tomography of abdomen ( CTA) in management of blunt abdominal trauma. J Trauma 1990; 30: 410-414. Stuart EM. Blunt hepatic trauma in adults. CT classification. Abd Gastrointes Radiol 1989; 25: 523-45. Croce MA, Fabian TC, Kudsk KA, Baum SL, Payne LW, Mangiante EC, et al. AAST organ injury scale: correlation of CT-gradded liver injuries and operative findings. J Trauma 1991; 31: 806-12. Carrillo EH, Platz A, Miller EB, Richardson JD, Polk HC Jr. Non-operative management of blunt hepatic trauma. Br J Surg 1998; 85: 461-8.