Introduction: The purpose of the study was to establish the role of score-based CT classification of hepatic lesions, peritoneal and retroperitoneal bleeding in the blunt hepatic trauma.
Material and methods: CT examinations of 47 haemodynamically stable patients, with isolated traumatic hepatic lesions were reviewed. CT scans were obtained with a spiral CT (thickness mm 10, pitch of 1) before and after 60 seconds after from intravenous administration of 140 cc of contrast medium at a rate of 2 cc/sec). Eleven out of 47 patients underwent surgery immediately after the CT examination, 2/47 patients in 48 hours; 34/47 patients were treated conservatively with CT follow-up on days 3 and 7, and before dimission discharge. The hepatic lesions, and degree of peritoneal and retroperitoneal haemorrhage were classified using the following scale: 1-5 for the hepatic lesions, in according to the Mirvis classification; 0-3 for peritoneal haemorrhage (0=no haemorrhage, 1=minor mild haemorrhage, 2=moderate haemorrhage, 3=major massive haemorrhage); 0-2 for retroperitoneal haemorrhage (0=no haemorrhage, 1=haemorrhage confined to the anterior pararenal space, 2=haemorrhage in 2 or more retroperitoneal spaces). The score was correlated to the treatment decisions (follow-up or surgery).
Results: Based on the hepatic lesion scores, we classified: 4 patients as grade 1 of grade 1, 9 as grade 2, 22 as grade 3, 11 as grade 4, 1 as grade 5; based on peritoneal haemorrhage, 14 patients as grade 0, 9 as grade 1, 8 as grade 2, and 10 as grade 3; based on retroperitoneal haemorrhage, 36 patients as grade 0 of grade 0, 3 as grade 1, and 8 as grade 2. The overall scores of the 13 patients that who underwent surgery were: 6 in 6 patients, 7 in 4 patients, 8, 9, and 10 in 1 patient.
Discussion and conclusions: CT is the modality of reference for evaluating traumatic hepatic lesions. The selection of patients for surgery requires an accurate classification and grading of the lesions. The classification of hepatic lesions alone, however, is not sufficient, as it does not take into account peritoneal and retroperitoneal haemorrhage, that which often occurs, and are correlated with the need for exploratory laparotomy. Integrated score-based evaluation of the hepatic lesions, peritoneal and retroperitoneal haemorrhage shows a good correlation with treatment decisions and clinical outcome.