Liver Trauma

Abstract

Objective: The aim of this section is to assess the evolution in the management of liver injuries during the last two decades. Methods:The authors reviewed the English literature, reporting the wider experiences, and on the basis of the personal experience, they suggest an up to date treatment.Results: Mortality due to hepatic injury has decreased over the past century from nearly 70% at the beginning of last century to the current level of 6-7%. This could be partially attributed to the improvement of operative techniques, to a lower surgical trend, to the application of damage control laparotomy in very complex liver trauma, and particularly to the diffusion of hepatic angiographic embolization. Scientific evidence has shown that more than 67% of laparotomies performed for blunt liver trauma are not therapeutic and in about 86% of all post-traumatic hepatic lesions the hemorrhage stopped spontaneously at the time of the laparotomy. On the other hand, blunt hepatic trauma can be conservatively treated in 70-90% of hemodynamic stable patients, in the absence of other associated lesions/peritoneal signs or in the case of limited need for transfusions. Thus far, the main decision criteria for a surgical rather than a conservative approach to the management of liver trauma have been the hemodynamic stability and not the American Association for the Surgery of Trauma-Organ Injury Scale (AAST-OIS) grading of the lesion. Conclusions:Restricting the indications for a conservative treatment of liver traumas solely to the relief of hemodynamic stability seems nowadays to be unreasonable. Criteria for a conservative treatment are as follows: hemodynamic stability, limited need of blood transfusions, and non-associated visceral lesions on CT scan. In the presence of these conditions non-operative approach

Liver Trauma: Management in the Emergency Setting and Medico-Legal Implications

“…For patients with grade I-II hepatic trauma associated with other injuries, mortality is approximately 13%, while the mortality rate increases for grade III, IV, V, and VI to 15%, 30%, 65%, and 95%, respectively [ 48 ]. Lesions involving the main hepatic veins or the retro-hepatic vena cava are often fatal [ 49 ]; additional predictors of mortality in grade IV-V injuries include intraoperative blood loss, hypothermia, acidosis, post-traumatic coagulopathy, and dysrhythmia [ 50 , 51 ].…”