Skip to main content

Advertisement

Log in

Recent Trends in Management of Liver Trauma

  • Original Article
  • Published:
Indian Journal of Surgery Aims and scope Submit manuscript

Abstract

The liver is the largest intrabdominal organ in the body with thin capsule and is more vulnerable to injury especially in blunt abdominal trauma. It is the second most common organ to be injured, but unfortunately liver injury contributes maximum in terms of mortality in intraabdominal trauma .The initial assessment and resuscitation should go together. The recent trend of NOM (nonoperative management) in liver trauma has been possible because of better understanding of the anatomy of the liver, pathophysiology of liver trauma, imaging modalities like FAST and CECT, and development of interventional radiology like angio-embolization. DCS (damage control surgery) also plays an important part in an unstable patient with liver trauma before undertaking definitive surgery once lethal triad of acidosis, hypothermia, and coagulopathy is corrected after DCS.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Similar content being viewed by others

References

  1. Carrillo EH, Wohltmann C, Richardson JD, Polk HC (2001) Evolution in the treatment of complex blunt liver injuries. Curr Probl Surg 38(1):A3–A60

    Article  Google Scholar 

  2. Marx JA (2002) Rosen’s emergency medicine: concepts and clinical practice, 5th edn. Mosby, St. Louis, pp 415–420

    Google Scholar 

  3. Chaudhry R, Sharma A (2016) Hepatic trauma. In: Pramod Kumar Mishra (ed) Textbook of Surgical Gastroenterology, vol 2, chapter 69; JP Medical Ltd

  4. Moore EE, Cogbill TH, Jurkovich GJ, Shackford SR, Malangoni MA, Champion HR (1995) Organ injury scaling: spleen and liver (1994 revision). J Trauma 38:323–324. https://doi.org/10.1097/00005373-199503000-00001

    Article  CAS  PubMed  Google Scholar 

  5. Mirvis SE, Whitley NO, Vainwright JR, Gens DR (1989) Blunt hepatic trauma in adults: CT-based classification and correlation with prognosis and treatment. Radiology 171:27–32

    Article  CAS  Google Scholar 

  6. Boese CK, Hackl M, Müller LP, Ruchholtz S, Frink M, Lechler P (2015) Nonoperative management of blunt hepatic trauma: a systematic review. J Trauma Acute Care Surg 79(4):654–660. https://doi.org/10.1097/TA.0000000000000814

    Article  PubMed  Google Scholar 

  7. Scalea TM, Rodriguez A, Chiu WC et al (1999) Focused assessment with sonography for trauma (FAST): results from an international consensus conference. J Trauma 46:466–472

    Article  CAS  Google Scholar 

  8. Chiu WC, Cushing BM, Rodriguez A et al (1997) Abdominal injuries without hemoperitoneum: a potential limitation of focused abdominal sonography for trauma (FAST). J Trauma 42:617–623

    Article  CAS  Google Scholar 

  9. Tian Z, Liu H, Su X, Fang Z, Dong Z, Yu C, Luo AK (2012) Role of elevated liver transaminase levels in the diagnosis of liver injury after blunt abdominal trauma. Exp Ther Med 4(2):255–260 Published online 2012 May 15

    Article  CAS  Google Scholar 

  10. Catalano O, Lobianco R, Raso MM, Siani A (2005) Blunt hepatic trauma: evaluation with contrast-enhanced sonography. J Ultrasound Med 24:299–310

    Article  Google Scholar 

  11. Pop PA (2012) Hepatic trauma management in polytraumatised patients. Chirurgia (Bucur) 107(5):591–597

    Google Scholar 

  12. Turnkey DD (2004) Hepatic trauma: contemporary management. Surg Clin North Am 84:437–450

    Article  Google Scholar 

  13. Fang JF et al (2006) The CT risk factors for the need of operative treatment in initially hemodynamically stable patients after blunt hepatic trauma. J Trauma 61(3):547–553

    Article  Google Scholar 

  14. Tan KK, Bang SL, Vijayan A, Chiu MT (2009) Hepatic enzymes have a role in the diagnosis of hepatic injury after blunt abdominal trauma. Injury 40(9):978–983. https://doi.org/10.1016/j.injury.2009.02.023

    Article  PubMed  Google Scholar 

  15. Chatoupis K, Papadopoulou G, Kaskarelis I (2013) New technology in the management of liver trauma. Ann Gastroenterol 26(1):41–44

    PubMed  PubMed Central  Google Scholar 

  16. Forlee MV, KrigeJE WCJ, Beningfield SJ (2004) Haemobilia after penetrating and blunt liver injury: treatment with selective hepatic artery embolisation. Injury 35(1):23–28

    Article  CAS  Google Scholar 

  17. Hagiwara A, Yukioka T, Ohta S et al (1997) Nonsurgical management of patients with blunt hepatic injury: efficacy of transcatheter arterial embolization. Am J Roentgenol 169:1151–1156

    Article  CAS  Google Scholar 

  18. Ciraulo DL, Luk S, Palter M et al (1998) Selective hepatic arterial embolization of grade IV and V blunt hepatic injuries. J Trauma 45:353–359

    Article  CAS  Google Scholar 

  19. Johnson JW, Gracias VH, Gupta R et al (2002) Hepatic angiography in patients undergoing damage control laparotomy. J Trauma 52:1102–1106

    Article  Google Scholar 

  20. Wahl WL, Ahrns KS, Brandt M et al (2002) The need for early angiographic embolization in blunt liver injuries. J Trauma 52:1097–1101

    Article  Google Scholar 

  21. Asensio JA, Roldan G, Petrone P et al (2003) Operative management and outcomes in 103 AAST-OIS grades IV and V complex hepatic injuries: trauma surgeons still need to operate, but angioembolization helps. J Trauma 54:647–654

    Article  Google Scholar 

  22. Mohr AM, Lavery RF, Barone P et al (2003) Angiographic embolization for liver injuries: low mortality, high morbidity. J Trauma 55:1077–1082

    Article  Google Scholar 

  23. Wallis A, Kelly MD, Jones L (2010) Angiography and embolisation for solid abdominal organ injury in adults—a current perspective. World J Emerg Surg 5:18

    Article  Google Scholar 

  24. Letoublon C, Morra I, Chen Y et al (2011) Hepatic arterial embolization in the management of blunt hepatic trauma: indications and complications. J Trauma 70:1032–1037

    PubMed  Google Scholar 

  25. Misselback TS, Teicher EJ, Cipolle MD et al (2009) Hepatic angioembolization in trauma patients: indications and complications. J Trauma 67:769–773

    Google Scholar 

  26. Monnin V, Sengel C, Thony F, Bricault I, Voirin D, Letoublon C, Broux C, Ferretti G (2008) Place of arterial embolisation in severe blunt hepatic trauma: a multidisciplinary approach. Cardiovasc Intervent Radiol 31:875–882

    Article  Google Scholar 

  27. Green CS, Bulger EM, Kwan SW (2016) Outcomes and complications of angioembolization for hepatic trauma: A systematic review of the literature. J Trauma Acute Care Surg 80(3):529–537. https://doi.org/10.1097/TA.0000000000000942

    Article  PubMed  PubMed Central  Google Scholar 

  28. Marr JDF, Krige JEJ, Terblanche J (2000) Analysis of 153 gunshot wounds of the liver. Br J Surg 87:1030–1034

    Article  CAS  Google Scholar 

  29. Ahmed N, Vernick JJ (2011) Management of liver trauma in adults, J Emerg Trauma Shock. 4(1):114–119. https://doi.org/10.4103/0974-2700.76846

Download references

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Rajan Chaudhry.

Additional information

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Chaudhry, R., Verma, A. Recent Trends in Management of Liver Trauma. Indian J Surg 83 (Suppl 3), 682–686 (2021). https://doi.org/10.1007/s12262-019-02056-2

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s12262-019-02056-2

Keywords

Navigation