Management and outcomes of traumatic liver injury: a tertiary care center experience

Abstract

Background Trauma is considered a significant public health problem worldwide. Abdominal trauma is generally divided into blunt and penetrating. Blunt trauma could affect any organ, and the sequelae of such injury may not always be clinically apparent. Liver injury is one of abdominal trauma's most critical and fundamental complications. We aimed to investigate the mechanism, type, and extent of injuries for patients with liver trauma and compare the outcomes between operative and non-operative management. Methods This retrospective study analyzed data of patients with liver injuries who presented to King Khalid University Hospital, King Saud University from 2016 to 2022. Management included conservative, conservative to laparotomy, laparotomy, and interventional radiological procedures, including hepatic artery angioembolization and percutaneous transhepatic drainage. Injury severity was graded based on the American Association for the Surgery of Trauma (AAST) liver injury scale. Results We analyzed 45 liver injury patients, with mean age of 29.3 years and most of them being male (77.8%). The most common injury mechanism was blunt trauma (86.7%), whereas penetrating injuries accounted only for 8.9% of cases. The most dominant type of injury was laceration (95.6%), followed by contusion (28.9%). Regarding liver injury severity, the majority of patients (37.8%) had a grade 3 injury level as per AAST liver injury scale. Among all patients, 31 (68.9%) were hemodynamically stable, whereas 14 patients (31.1%) were unstable, with a mortality rate of 2.2%. Most patients (82.2%) underwent conservative management. Six patients (13.3%) require surgical laparotomy. Two patients (4.4%) who underwent conservative management first needed surgical laparotomy. The complication rate was 24.4%, with delirium being the most common (6, 13.3%), followed by fever and sepsis (3, 6.7%) and acute renal failure, pneumonia, cardiac arrest, biliary leaks, meningitis/seizures, which were all reported in a subset of patients. Conclusions Liver trauma is considered a significant public health problem worldwide. The management of traumatic liver injuries has evolved significantly over the years, with the addition of interventional radiological modalities, a more inclined approach toward non-operative management.