Liver Trauma

Chapter

Abstract

In patients with suspected intra-abdominal injuries after blunt trauma, immediate operation is indicated in the setting of refractory shock with hemoperitoneum demonstrated on ultrasound or diagnostic peritoneal lavage. Otherwise computerized tomographic (CT) scanning should almost always be done if possible. If a liver injury is identified on CT, the decision to pursue nonoperative management (NOM) hinges on the severity of the physiologic derangement, and the presence or absence of peritonitis. CT characteristics of the liver injury such as grade of liver injury, presence of a vascular “blush” or contrast extravasation, the degree of hemoperitoneum, and presence of associated injuries should also be considered in the decision to pursue NOM. Angioembolization is an important modality which can be utilized as the primary therapeutic intervention when NOM is pursued, or as an adjunct to operative management where hemostasis is less than satisfactory. The decision to proceed with angiography in the latter scenario is usually made on the basis of operative findings and clinical course although a recent study has also demonstrated some value in postoperative CT scanning to guide the need for angiography [1].

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Copyright information

© Springer International Publishing AG, part of Springer Nature 2018

Authors and Affiliations

  1. 1.Department of SurgeryUniversity of PennsylvaniaPhiladelphiaUSA
  2. 2.Department of SurgeryReading Health SystemReadingUSA
  3. 3.Virginia Commonwealth UniversityRichmondUSA

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