Contemporary management in liver injury


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.


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Labels
Surgery Traumatology Trauma surgery
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