Contemporary management in liver injury

Czech version

Authors: František Vyhnánek
Authors‘ workplace: Traumatologické centrum FNKV, Chirurgická klinika 3. LF UK, Praha
Published in: Úraz chir. 20., 2012, č.2

Overview

Introduction:
The liver is the second most frequently injured abdominal organ. Blunt and penetrating liver trauma is frequently associated with diagnostic and therapeutic problems. Majority patients with liver trauma are treated successfuly with increasing experience nonoperatively. Therefore mortality decreased in patients with liver trauma during last decennaries.

Methods, results:
There are presented contemporary managements in liver trauma. Multidisciplinary approachs in diagnostic and therapeutic management in liver trauma is based on haemodynamic stability.Mostly nonoperative management is proceeded in stable patients with grade IIII liver trauma. In unstable patients is indicated urgent laparotomy with damage control techniques. Result of treatment patients with complex liver trauma (grade IVV) depend on agressive treatment of hypothermia, coagulopathy, acidosis and surgical control of haemorrhaging frequently used technigue of perihepatic packing. Nonanatomical liver resection (resectional debridement) is recommended in selected patients when there is unviable parenchyma. Anatomical resection is generally reserved for a devascularised lobe with major ductal injury. In penetrating liver injury , where is often associated injuries of other intraabdominal organs is indicated urgent laparotomy. Interventional radiological techniques is indicated in treatment of vascular injuries or complications nonoperative or surgical management.

Conclusions:
Management in treatment of liver trauma involve general principles of management in serious abdominal trauma. Diagnostic and therapeutic procedures is indicated according haemodynamic stability.

Management in stable patients is according results of MDCT. Unstable patient with haemoperitoneum suspicion is indicated for urgent laparotomy. Surgical techniques in majority serious liver injuries involves damage control techniques. Success of management in patients with complex liver trauma in polytrauma patients depend on immediate time limited surgical procedure and agressive control of hypothermia, coagulopathy and acidosis.

KEY WORDS:
liver injury, nonoperative and surgical treatment.

Sources

1. BADGER, S.A., BARCLAY, R., CAMPBELL, P. et al. Management of liver trauma. World J Surg. 2009, 33, 2522–2537.

2. Di SAVERIO, S., CATENA, F., FILICORI, F., et al. Predictive factors of morbidity and mortality in grade IV and V liver trauma undergoing perihepatic pac-king: Single institution 14 years experience at Euro-pean trauma centre. Injury. 2012, 43, 1347–1354.

3. GOFFETTE, P.P., LATERRE, P-F. Traumatic inju-ries: imaging and intervention in post-traumatic complications (delayed intervention). Eur Radiol. 2002, 12, 994–1021.

4. JIANG, H., WANG, J. Emergency strategies and trends in the management of liver trauma. Front Med. 2012, 6, 1–8.

5. Li PETRI, S., GRUTTADAURIA, S., PAGANO, D., et al. Surgical management of complex liver trauma: a single liver transplant center experience. Am Surg. 2012, 78, 20–25.

6. PEITZMAN, A.B., MARSH, J.W. Advanced optative techniques in management of complex liver injury. J Trauma Acute Care Surg. 2012, 73, 765–770.

7. PIPER, G.L., PEITZMAN, A.B. Current manage-ment of hepatic trauma. Surg Clin North Am. 2010, 90, 775–786.

8. POLANCO, P., LEON , S., PINEDA, J. et al. Hepatic resection in the management of complex injury to the liver. J Trauma. 2008, 65, 1269–1270.

9. SWIFT, C., GARNER, J.P. Non-operative manage-ment of liver trauma. J R Army Med Corps. 2012, 158, 85–95.

10. VAN DER WILDEN, G.M., VELMAHOS, G.C., EMHOFF, T. et al. Successful nonoperative mana-gement of the most severe blunt liver injuries: a multicenter study of the resech consortium of new England centers for trauma. Arch Surg. 2012, 147, 423–428.

Labels

Surgery Traumatology Trauma surgery

Chest trauma in a district hospital

Lower extremity vascular injury

Article was published in

Trauma Surgery

2012 Issue 2