Blunt Trauma Liver-Conservative or Surgical Management: A Retrospective Study

Abstract

IntroductionThe relatively fixed position of the liver and its large size makes it more prone for injury in blunt trauma of the abdomen. Liver and spleen together, account for 75% of injuries in blunt abdominal trauma. Though liver is the second most commonly injured organ in abdominal trauma; it is the most common cause of death following abdominal injury. Compared to splenic injuries, management of liver trauma still remains a challenge in the best of trauma centres [1,2].In the past, most liver injuries were treated surgically. However evidence confirms that about 86% of liver injuries have stopped bleeding by the time surgical exploration is performed and 67% of laparotomies done for blunt trauma abdomen are non-therapeutic. Imaging techniques especially Computerised Tomographic (CT) scan has created remarkable impact in managing liver trauma patients by reducing the number of laparotomies. About 80% of adults and 97% of children are presently managed conservatively worldwide at high volume trauma centres [3,4].The large size of the liver, the friable parenchyma, its thin capsule and its relatively fixed position make it prone to blunt injury. Right lobe is more often involved, owing to its larger size and proximity to the ribs [5,6]. Compression against the fixed ribs, spine or posterior abdominal wall results in predominant damage to segments 6, 7 and 8 of the liver (>85%). Pressure on right hemithorax may propagate through the diaphragm producing contusion of dome of right lobe of liver. Liver's ligamentous attachments to diaphragm and posterior abdominal wall act as sites of shearing forces during deceleration injury. Liver injury can also occur as a result of transmission of excessively high venous pressure to remote body sites at the time of impact. Weaker connective tissue framework, relatively large size and incomplete maturation and more flexible ribs account for higher chance of liver injury in children compared to adults.Deceleration injuries producing shearing forces may tear hepatic lobes and often involve the inferior vena cava and hepatic veins. A steering column injury can damage an entire lobe. Liver trauma may result in subcapsular/intrahepatic hematomas, lacerations, contusions, hepatic vascular injury and bile duct injury. Most blunt trauma livers (80% in adults and 97% in children) are treated conservatively [7,8].Conservative treatment mandates repeated clinical monitoring and surgical intervention if conservative treatment fails. A comparison of patients receiving operative and nonoperative treatment of liver Abstract Background: The liver is one of the most frequently damaged organs and remains the most common cause of death following blunt abdominal trauma. Currently, a conservative management constitutes the treatment of choice in patients with hemodynamic stability. The aim of this study is to evaluate the results of an operative and conservative management of 55 patients with liver injury treated in a single institution.