The injured liver: management and hepatic injuries in the traumapatient

Abstract

Trauma is a global problem, and carries a high price that is paid by individuals, communities, and nations. Road traffic accidents, industrial injuries, farming accidents and interpersonal violence account for traumatic injuries with varying prevalences throughout the world. Globally the liver is the most frequent injured intra-abdominal organ following trauma. Selection of patients with liver injuries for nonoperative management, definitive surgical repair or a damage control laparotomy is the topic of ongoing debates. The surgeon, who encounters a severely injured patient with a liver injury, will rapidly need to make several critical decisions. Nonoperative Management of hemodynamically stable patients following blunt and

penetrating hepatic trauma is safe in adequately selected patients. Use of damage

control techniques is recommended in patients with a major hepatic bleeding or in patients with a minor liver injury with associated vascular injury and before the onset of metabolic failure. As a result of improved survival following severe hepatic parenchymal damage an increase in intrahepatic vascular and biliary complications has become evident. Many of these complications can be prevented by surgical ligation if a laparotomy is warranted, or can be managed by less invasive, percutaneous techniques in the acute (vascular) or secondary (biliary) stage.