Liver injury following blunt abdominal trauma: a new mechanism-driven classification

Abstract

PurposesThe current classifications for blunt liver trauma focus only on the extent of liver injury. However, these scores are independent from the localization of liver injury and mechanism of trauma.MethodsThe type of liver injury after blunt abdominal trauma was newly classified as type A when it was along the falciform ligament with involvement of segments IVa/b, III, or II, and type B when there was involvement of segments V–VIII. With the use of a prospectively established database, the clinical, perioperative, and outcome data were analyzed regarding the trauma mechanism, as well as the radiological and intraoperative findings.ResultsIn 64 patients, the type of liver injury following blunt abdominal trauma was clearly linked with the mechanism of trauma: type A injuries (n = 28) were associated with a frontal trauma, whereas type B injuries (n = 36) were found after complex trauma mechanisms. The demographic data, mortality, ICU stay, and hospital stay showed no significant differences between the two groups. Interestingly, all patients with type A ruptures required immediate surgical intervention, whereas six patients (16.7 %) with type B ruptures could be managed conservatively.ConclusionsThis new classification for blunt traumatic hepatic injury is based on the localization of parenchymal disruption and correlates with the mechanism of trauma. The type of liver injury correlated with the necessity for surgical therapy.

Clinical and radiological presentation in patients with conserved blunt liver and splenic injuries at a tertiary care center in western India

“…A study carried out by Slotta et al, showed a male:female ratio of 42:22. 1 Similarly, a study carried out by Patel et al, showed a ratio of 39:3. Also, a study carried out by Mucha P et al showed a male:female ratio 163:74 i.e.…”

“…after 24-48hrs) after the trauma. 1 In India, we frequently still encounter patients presenting late after abdominal injury and therefore all that is current in the literature may not be directly applicable to our situation. A better understanding of the function of spleen and its function especially in immunological defense has led to the practice of conserving Spleen in blunt abdominal injuries.…”

An Interesting Case of Deceleration Injury to Liver Requiring Hepatectomy

“…It is to be noted that liver injuries due to blunt force trauma are mainly associated with the right lobe (67.6%) [6] which is better tolerated than the left lobe which allows for the selection of a conservative non operative treatment approach in these patients. Slotta [7] developed a classification, based on the localization of liver injury and the mechanism of the underlying blunt liver trauma, into two types: Type A, involving the left liver lobe mostly along the falciform and Type B injury, which though considered more complex injuries than Type A, are localised to the right lobe but are associated with no increase in mortality than type A injuries.…”

Is there a relation between liver transaminases levels and liver injury due to abdominal trauma of patients underwent operation?

“…Liver is the most often injured organ due to abdominal trauma with its big dimension and its fixed position (1). In recent years the management of liver injury all over the world is going to include conservative management and thus aimed to avoid from any unnecessary surgery.…”