BLUNT LIVER TRAUMA.
Objectives: To study the incidence, grade, cause type and the management for patients with blunt liver trauma.
Methods: This study was carried on 58 patients who sustained blunt liver trauma. Patients were managed at the emergency unit of the main Alexandria University Hospital. Clinical examination and assessment of injury severity were done. Ultrasound and CT examination of the abdomen were performed. The types, mechanisms and grade of injuries were recorded. Management of patients whether operative or non-operative was noted and they were followed to diagnose possible complications and the morbidity and mortality were assessed.
Results: There were 46 males and 12 females. Their ages ranged from 3 to 62 years with a mean value of 24 years. Liver injury represented 0.33% of all emergency department admissions and 0.53% of all trauma cases. Liver injury occurred in 30% of cases of abdominal trauma and was the commonest abdominal organ injured. The commonest mechanism of injury was road traffic accident (60.34%). Liver injuries encountered were grade III in 24% of the cases. Twenty nine patients (50 %) were managed non-operatively with a success rate of 96.55%. Conservative management failed in one case due to active bleeding from an associated tear in the mesentry of the small intestine. Twenty seven patients were managed operatively (46.55%). Hemodynamic instability (24.14%) was the commonest indication for surgery. Fourteen patients (51.85 %) were managed by simple haemostatic measures and /or suturing and only 2.38% had to undergo a major hepatic procedure in the form right hepatectomy. The overall morbidity was 41.38%. Pyrexia was the commonest complication (17.24%). Associated extra-abdominal injuries occurred in 44.83% of the cases and chest trauma was the commonest associated injury (37.93%). Associated abdominal injuries occurred in 41.38% and the spleen was the commonest associated organ injured (16.07%). The overall mortality was 22.4%. Most of the deaths (53.8%) occurred in the early post-operative period from irreversible shock and/or disseminated intravascular coagulation, while 16.67% died intra-operatively from uncontrolled bleeding. No deaths were reported in the non-operative group.
Conclusion: Non-operative management should be the initial approach to all patients with blunt liver injury if hemodynamically stable. This shift in management from surgery is explained by the improvement in the imaging techniques and the new concepts in the angiographic management of intra-hepatic vascular injuries.
Key words: blunt liver injury, management.
• GCS: Glasgow coma scale • RTS: Revised trauma score
• AAST: American Association for the Surgery of Trauma Hepatic Injury Scale