Liver trauma

Reviewed and revised 21 December 2015

OVERVIEW

• Liver trauma may result from blunt or penetrating abdominal injury
• The liver is the most commonly injured organ in penetrating abdominal trauma

ASSESSMENT

• Abdominal pain, localized tenderness (RUQ)
• Possible hemorrhagic shock
• CT abdomen with IV contrast is the investigation of choice (liver injuries are graded I to VI according to severity)

GRADING

American Association for Surgery of Trauma Organ Injury Scale based on:

• haematoma size (% surface area)
• laceration size (parenchymal depth)
• vessel involvement
• integrity of liver
• vascular status

Grade          Description of Injury

I                       small (<10%, < 1cm)

II                     moderate (10-50%, < 10cm)

III                    large (>50%, > 10cm or expanding)

IV                     large with parenchymal disruption (>25% of a hepatic lobe)

V                      large with parenchymal disruption (> 75% of a hepatic lobe) or juxtahepatic venous injury

VI                     hepatic avulsion

MANAGEMENT

• ATLS approach
• Most haemodynamically stable injuries can be managed non-operatively
• Angiography with embolization should be considered if:
  — a contrast blush is seen on CT
  — evidence of ongoing bleeding
• Operative management may initially adopt a damage control approach with simple packing only followed by definitive procedure when haemodynamically stable
• Interventional modalities may be used to treat complications such a biloma, hepatic abscess, etc (e.g. ERCP, percutaneous drainage, laparoscopy)

Reference and Links

FOAM and web resources

• Trauma Professional’s Blog — EAST Guidelines Update: Liver Injury
• ED Trauma Critical Care —Blunt Abdominal Trauma Part 2 – Grading Hepatic Injury