Injuries to the Liver: Analysis of 20 Cases

Abstract

Twenty cases of liver injury among 55 consecutive cases of abdominal injury submitted to laparotomy over a four-year period are reported. Forty-four of the cases were blunt injuries, and the cases of liver injury were in this group. Road traffic accidents accounted for 37 of the 44 cases and 17 of the 20 liver injuries. Except in two cases injury to the liver was associated with injury to other organs. Severe chest injury was found in 40% of the cases and serious skeletal injury in 45%. The overall mortality in blunt injury to the liver was 20% (4 cases) and was directly attributable to the liver injury in only one case.Liver injuries are classified as minor or major according to the depth of the wound and the associated destruction of liver tissue. Liver resection is advocated for major injuries. Right hepatic lobectomy was performed on five occasions and three of the patients survived. Death in the other two was due to associated injuries. The remarkable regenerative capacity of the liver is emphasized.

Hepatic resection for trauma, tumour and biliary obstruction

“…Such arguments are valid but should be tempered by the realization that it is difficult to determine the true mortality of liver injury alone. Factors such as speed of transfer to hospital, the number of other organs injured and the experience of the surgical team should be taken into account and mortality figures of 30 per cent or less are now regularly recorded (Little and Williams, 1969;Walt, 1969;Blumgart and Vajrabukka, 1972). In our experience, 3 out of 15 patients (20 per cent) have died following resection for major blunt injury.…”

“…Wounds accompanied by much devitalization of liver tissue warrant resectional methods in their treatment (Blumgart and Vajrabukka, 1972;Blumgart, 1978). Resectional dkbridement may be safely employed to remove large amounts of devitalized liver tissue since it exposes the underlying blood and biliary vessels which may be controlled by direct suture ligation.…”

“…Liver tissue was sectioned using a combination of incision, diathermy and the finger fracture dissection technique (Foster and Berman, 1977). The hepatic veins were frequently approached from within the liver substance, especially in resection for trauma (Blumgart and Vajrabukka, 1972). In patients with large turnours extending close to the vena cava, formal dissection of the hepatic veins was carefully carried out from below upwards, thus allowing the liver substance to be lifted free from the vena cava.…”

Postoperative problems and management after hepatic resection for blunt injury to the liver

“…THE mortality for blunt liver injuries has decreased from 60 per cent (Mikesky et al, 1956;Foster et al, 1968) to 30 per cent or less (Little and Williams, 1969;Walt, 1969;Blumgart and Vajrabukka, 1972;Donovan et al, 1973). The improvement has been the result of better techniques of resuscitation, adequate blood transfusion and improved management of the more extensive injuries.…”

Abdominal trauma: a report of 129 cases

“…Injuries to the liver (seventeen cases) Blumgart & Vajrabukka (1972) have defined minor liver injury as one that can be closed to its full depth by simple suture with control of haemorrhage and little associated parenchymal damage. Using this classification there were ten minor and seven major injuries of the liver.…”