AffiliationHepatobiliary Surgical Unit, Mater Hospital, Crumlin Road, Belfast, BT14 6AB, Northern Ireland, UK. Stephen@Badger.tc
MetadataShow full item record
CitationWorld J Surg. 2009 Dec;33(12):2522-37.
JournalWorld journal of surgery
AbstractBACKGROUND: Blunt and penetrating liver trauma is common and often presents major diagnostic and management problems. METHODS: A literature review was undertaken to determine the current consensus on investigation and management strategies. RESULTS: The liver is the most frequently injured organ following abdominal trauma. Immediate assessment with ultrasound has replaced diagnostic peritoneal lavage in the resuscitation room, but computerised tomography remains the gold standard investigation. Nonoperative management is preferred in stable patients but laparotomy is indicated in unstable patients. Damage control techniques such as perihepatic packing, hepatotomy plus direct suture, and resectional debridement are recommended. Major complex surgical procedures such as anatomical resection or atriocaval shunting are now thought to be redundant in the emergency setting. Packing is also recommended for the inexperienced surgeon to allow control and stabilisation prior to transfer to a tertiary centre. Interventional radiological techniques are becoming more widely used, particularly in patients who are being managed nonoperatively or have been stabilised by perihepatic packing. CONCLUSIONS: Management of liver injuries has evolved significantly throughout the last two decades. In the absence of other abdominal injuries, operative management can usually be avoided. Patients with more complex injuries or subsequent complications should be transferred to a specialist centre to optimise final outcome.
- Surgical management and outcome of blunt major liver injuries: experience of damage control laparotomy with perihepatic packing in one trauma centre.
- Authors: Lin BC, Fang JF, Chen RJ, Wong YC, Hsu YP
- Issue date: 2014 Jan
- Management of liver trauma.
- Authors: Parks RW, Chrysos E, Diamond T
- Issue date: 1999 Sep
- Liver trauma in 446 patients.
- Authors: Krige JE, Bornman PC, Terblanche J
- Issue date: 1997 Feb
- Selective nonoperative management of penetrating abdominal solid organ injuries.
- Authors: Demetriades D, Hadjizacharia P, Constantinou C, Brown C, Inaba K, Rhee P, Salim A
- Issue date: 2006 Oct
- The current management of hepatic trauma.
- Authors: Carrillo EH, Richardson JD
- Issue date: 2001