Liver injury

The liver is the most commonly injured intraabdominal organ with an incidence of 30% to 40% with the overwhelming majority being minor injuries. Perhaps the single greatest advance in the management of hepatic trauma over the past two decades has been the advancement and remarkable success of nonoperative management, selective operative management, and hepatic angioembolization of hepatic injuries. The overall liver-related mortality rate in most large series of nonoperatively managed blunt hepatic injuries is 0.5%. Most liver-related fatalities result from complex hepatic trauma (grades IV and V), especially juxtahepatic venous injuries and portal triad injuries. The majority of blunt hepatic trauma patients can be successfully managed nonoperatively if the patient is hemodynamically stable and without signs of peritonitis. Should the patient under observation become hemodynamically unstable or develop peritoneal signs, operative intervention should be undertaken immediately. Several operative techniques and maneuvers are described to achieve hemorrhage control in the patient with complex liver injuries.