Hepatic injury

Abstract

Hepatic trauma occurs in approximately 5% of all admissions in emergency rooms. The anatomic location and the size of the liver make the organ even more susceptible to trauma and frequently in penetrating injuries. The American Association for the Surgery of Trauma established a detailed classification system that provides for uniform comparisons of hepatic injury. Diagnosis of hepatic injury can be sometimes easy; however the use diagnostic modalities as diagnostic peritoneal lavage, ultrasound and computed tomography allow faster and more accurate diagnosis. Nonoperative management of the hemodynamically stable patient with blunt injury has become the standard of care in most trauma centers. Few penetrating abdominal lesions allow conservative management; exceptions can be some penetrating wounds to right upper abdominal quadrant. Operative treatment of minor liver injuries requires no fixation or can only be managed with eletrocautery or little sutures. Major liver injuries continue, despite technical advances, a challenge to surgeons. Many procedures can be done as direct repair, debridement associated to resections, or even in more severe lesions, packing. This constitutes a damage control which can allow time to recovery of patient and decreasing mortality shortly after trauma.

Seatbelt use is associated with lower risk of high-grade hepatic injury in motor vehicle crashes in a national sample

“…Blunt abdominal trauma is often sustained during an MVC and accounts for a significant portion of crash-related injury 4. Liver injuries are the second most common outcome of blunt abdominal trauma, due to size and location within the abdomen,5 and can be life-threatening 6…”

About Usefulness of Kalemia Monitoring after Blunt Liver Trauma

“…Liver is a particularly vulnerable organ because of its size, the fixed position in the right hypochondrium, and the strict anatomical relationships with duodenum and pancreas [10]. …”

Abordagem dos pedículos glissonianos no manejo do trauma hepático

“…The small liver wounds can be fixed using the eletrocautery, argon bean or even little suture lines grabbing the injured site that can be anchor by omentum strips, if possible from the right side of the greater omentum sac. 13,14 Hirshberg and Mattox well stated the fundamental steps to handle a grade IV or V hepatic injury during laparotomy. It starts with control of the bleeding that can usually achieve by manual compression, temporary packing and Pringle maneuver.…”