Tratamiento no operatorio de traumatismos de hígado y bazo. Experiencia clínica

Background: There is a tendency towards conservative behaviours in the treatment of blunt abdominal trauma. Aim: To perform a retrospective analysis of the results of conservative management of liver and spleen trauma. Patients and methods: Clinical charts of 21 patients with traumatic lesions of liver or spleen that were not operated, seen between 1991 and 1996, were reviewed. Severity of trauma was assessed according to the Abbreviated injury scale of 1985 and CAT scan lesions were scored according to scale proposed by the American Association of Trauma Surgery. Results: Mean age of patients tuas 33.4 years old and 17 were male. Twelve patients had liver trauma, that had a mean severity index of 20.1. According to abdominal CAT scan, two patients had grade II lesions, 8 had grade III lesions and 2 had grade IV lesions. Two patients required transfusions and all had a successful recovery. Nine patients had spleen trauma, with a severity score of 24.4. Three patients required transfusions and one was subjected to a splenectomy. Mean hospital stay was 17.8 days for patients with liver trauma and 16 days for patients with spleen trauma. Conclusions: Non operative management of liver and spleen trauma is feasible and safe in a selected group of patients, independent of the degree of injury and hemoperitoneum.