An approach to selective conservative management of liver injuries

Experience with liver trauma in the USA and Europe differs with respect to penetrating and blunt injuries and an Irish survey of 78 liver injuries is analysed. Of the cases analysed, 69 were due to blunt trauma (88%), while the remaining 9 cases (12%) were due to penetrating injury; the mean age of the survey group was 28 years. Abdominal signs predominated in 64% while 40% were shocked. Diagnostic peritoneal lavage was carried out in 14 patients (58% accuracy), ultrasonography in five and hepatic scintigraphy in two. Laparotomy was carried out in 67 patients. Injury was confined to the right lobe in 51, the left lobe in 14 and both lobes in two. Direct suture was carried out in 45, vascular ligation in three, and four had normal hepatic lobectomies. Ten patients were stabilised by packing and transferred for definitive treatment. Other abdominal injuries were present in 37% and chest injuries in 24%, mostly in the blunt trauma group. Four patients died (5%) but complications were evident in 59%. Ninety-three per cent of complications and all deaths occurred in the more serious blunt trauma group.