Nonoperative management of intrahepatic hemorrhage and hematoma following blunt trauma.

Four patients with blunt abdominal trauma did not have surgical treatment for intrahepatic hemorrhage and hematoma. Two patients were diagnosed 24 hours after injury as having significant active hemorrhage, although their clinical status was stable. They were successfully treated by superselective transcatheter occlusion of the hepatic artery and they recovered without incident. Two patients were diagnosed one week after injury as having quiescent intrahepatic hematoma and they too recovered without complication. Although more patients will have to be evaluated, it is our belief that nonoperative management of selected patients with an intrahepatic hematoma is reasonable and safe. Patients should be observed periodically with radioisotope scans, ultrasound or computerized tomography until the hematoma resolves.