Computed tomography and its role in conservative therapy of liver trauma
Tomography, X-Ray Computed
Increasing experience with early radiological evaluation by ultrasound (US) and computed tomography (CT) of patients with abdominal trauma is leading to more frequent use of conservative treatment in patients with severe liver injuries. In a retrospective study with predominant use of peritoneal lavage only 3 out of 100 patients with liver injuries were treated non-surgically. In a consecutive prospectively evaluated series of 75 patients with early use of US and CT, 30 patients in stable circulatory conditions were treated non-surgically. With increasing experience a higher percentage of patients, even with severe liver injuries, could be treated non-operatively. 17 patients with minor injuries (grade I and II, modified according to Moore) and 13 patients with severe injuries (grade III and IV) could be treated non-surgically. 2 patients with grade IV injury developed an arterial/portal-venous fistula and an arterial aneurysm which necessitated radiological embolizations. All conservatively treated patients have been followed up for a mean period of 18 months without complications. Although a precise anatomical classification of the liver injury degree seems difficult, the predictive value of computed tomography for non-surgical treatment was good. Use of i.v.-contrast is mandatory. We conclude that in experienced hands computed tomography allows precise evaluation of liver injuries for adequate treatment, provided careful follow-up (intensive care unit, CT, angiography) ensues to avoid complications.