Changes in the Management of Injuries to the Liver and Spleen

Abstract

At the completion of my residency training in 1976, there were relatively few controversies in the treatment of injuries to the liver and spleen. Diagnosis of these injuries usually could be made by physical examination, positive diagnostic peritoneal lavage (DPL), or at operation mandated by a penetrating wound. If injury to the spleen occurred, splenectomy was indicated. Diagnosis of liver injury was likewise noncontroversial, and only the methods of treatment of the hepatic lesions engendered debate. But by the end of the last century, virtually none of the dogma believed to be unequivocally true 25 years earlier was practiced. The majority of splenic injuries were detected by CT scan and treated without operation. Liver injuries that resulted in several liters of blood and bile in the abdomen were observed if the blood pressure could be maintained with several units of blood. A surgical Rip Van Winkle, who awoke in 2000 after 25 years of slumber, would never have believed the radical changes that occurred in the treatment of injuries to these solid organs, whose diagnosis and management had once seemed so straightforward.