Delayed celiotomy for the treatment of bile leak, compartment syndrome, and other hazards of nonoperative management of blunt liver injury

Robert Goldman, Monica Zilkoski, Richard Mullins, John Mayberry, Clifford Deveney, Donald Trunkey

Research output: Contribution to journalArticle

39 Scopus citations

Abstract

Background: Management of blunt liver injury is predominately nonoperative. However, complications occur in 10% to 25% of patients, with half taking place more than 24 hours after injury. Few reports have addressed the management of the new pattern of these delayed complications, which is the objective of this study. Methods: Adult patients admitted to our level one trauma center from 1995 to 2000 with blunt liver injury were identified. Demographic, physiologic and laboratory data, computed tomography (CT) and operative findings, and complications were reviewed. Results: Blunt liver injury was identified in 192 patients. Thirty-nine patients (20%) underwent immediate celiotomy. The remaining 153 patients were initially managed nonoperatively. Liver-related complications developed in 19 (12%) patients. Fifteen patients underwent delayed celiotomy to treat secondary inflammatory processes, from bile leak (6), hemorrhage (5), and hepatic abscess (1), and to treat abdominal compartment syndrome (2), and decompress hepatic compartment syndrome (1). Although no deaths or complications were directly caused by delayed celiotomy, 2 deaths (11%), occurring early in this series, were attributed to liver-related complications. Conclusions: These complications, occurring in 12% of patients with liver injuries, may be a consequence of initial nonoperative management. Although these findings do not negate nonoperative management of blunt liver injury, this approach can be hazardous and requires diligence to recognize and treat delayed and potentially fatal complications.

Original languageEnglish (US)
Pages (from-to)492-497
Number of pages6
JournalAmerican journal of surgery
Volume185
Issue number5
DOIs
StatePublished - May 1 2003

Keywords

  • Bile leak
  • Blunt liver injury
  • Compartment syndrome
  • Delayed celiotomy
  • Delayed complications

ASJC Scopus subject areas

  • Surgery

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