Management of Liver Trauma in Minia University Hospital, Egypt

Abstract

The aim of this study is to present the outcome of operative and non-operative management of patients with liver injury treated in a single institution depending on imaging. This study was conducted at the Causality Unit of Minia University Hospital, and included 60 patients with hepatic trauma from March 2012 to January 2013. In our study, males represent 80 % while females represent 20 % of the traumatized patients. The peak age for trauma found was 11-30 years. Blunt trauma is the most common cause of liver injury as it was the cause in 48 patients (80 %). Firearm injuries are the most common cause of penetrating trauma (60 %) followed by stab injuries (40 %). More than one half of our patients (34 out of 60) were treated with non-operative management (NOM) with a high success rate. The operative procedures done were suture hepatorrhaphy (20 cases), non-anatomical resection in one case, anatomical resection in one case, and damage control therapy using pads in two cases. In another two cases, nothing was done as subcapsular hematoma had resolved. Minia University Hospital is a big tertiary Hospital in Egypt at which blunt liver trauma is more common than penetrating liver trauma. Surgery is no longer the only option available. It has been reserved for extensive lesions with condition of hemodynamic instability or for the treatment of the complications. NOM is an effective treatment modality in most cases.

Predictors of failure in non-operative management of blunt liver trauma

“…NOM could be the choice depends on the severity of liver blunt trauma and associated injuries. 5,7 Kozar et al, in his study revealed that global complication rate of NOM is 14 % but for grade V injuries the rate was higher around 52%. 31 Grade of liver injury can reflect the degree of hepatic parenchymal damage.…”

“…1,3,5,16 Management of liver injury depends on patient's condition, diagnosis, transfusion requirement, complication, as well as the hospital facilities to make a diagnosis and treatment. Non-operative management of liver injuries has gained wide support and adopted for approximately 80% of blunt liver injuries.…”

“…Grade VI injuries are not salvageable. 3,5,31 She et al, present that morbidity and mortality tend to worsen with a higher grade of liver injury. 1 In our study, a higher grade of liver injury requires a surgery, but the mortality rate is also getting higher.…”

“…2 Liver trauma is the second most frequent event during an abdominal trauma and is the leading cause of death (20-40%) in these cases. 5 Most liver injuries (>85%) involve segments 6, 7, and 8 of the liver, due to simple compression against the fixed ribs, spine, or posterior abdominal wall. Also, pressure through the right hemithorax may propagate through the diaphragm, causing a contusion of the dome of the right lobe of the liver.…”

“…Also, pressure through the right hemithorax may propagate through the diaphragm, causing a contusion of the dome of the right lobe of the liver. 1,4,5 Furthermore, ligamentous attachment of the liver to the diaphragm and the posterior abdominal wall can act as sites of shear forces during deceleration injury. 5,6 Associated injury to other organs increases the risk of complications and death.…”