Outcomes following liver trauma in equestrian accidents

Abstract

BackgroundEquestrian sports are common outdoor activities that may carry a risk of liver injury. Due to the relative infrequency of equestrian accidents the injury patterns and outcomes associated with liver trauma in these patients have not been well characterized.MethodsWe examined our experience of the management of equestrian liver trauma in our regional hepatopancreaticobiliary unit at a tertiary referral center. The medical records of patients who sustained liver trauma secondary to equestrian activities were analysed for parameters such as demographic data, liver function tests, patterns of injury, radiological findings, the need for intervention and outcomes.Results20 patients sustained liver trauma after falling from or being kicked by a horse. The majority of patients were haemodynamically stable on admission. Alanine transaminase (ALT) levels were elevated in all patients and right-sided rib fractures were a frequently associated finding. CT demonstrated laceration of the liver in 12 patients, contusion in 3 and subcapsular haematoma in 2. The right lobe of the liver was most commonly affected. Only two patients required laparotomy and liver resection; the remaining 18 were successfully managed conservatively.ConclusionsThe risk of liver injury following a horse kick or falling off a horse should not be overlooked. Early CT imaging is advised in these patients, particularly in the presence of high ALT levels and concomitant chest injuries such as rib fractures. Despite significant liver trauma, conservative management in the form of close observation, ideally in a high-dependency setting, is often sufficient. Laparotomy is only rarely warranted and associated with a significantly higher risk of post-operative bile leaks.

Report of Four Cases with Equestrian Injury: Therapeutic Approach and Outcome

“…Moreover, the investigators highlighted that reduction in head trauma coincides with reduction of mortality due to equestrian injury. Balakrishnan et al [ 6 ] evaluated 20 patients with liver trauma caused by equestrian injury, reporting that laparotomy is rarely warranted and conservative management in the form of close observation may be sufficient. In the present cases, conservative management was also successfully performed.…”

Horse kick injury mimicking a handle bar injury or a hidden speared injury

“…Among the 33 human reports of a horse kick injury, 20 were case reports, while the other 13 included one prospective study, seven retrospective studies, three surveys using questionnaires, and two reviews . The case reports are summarized in Table , and all reports other than case reports are summarized in Table . Cardiac rupture and/or lethal head injuries induced by horse kicks have not been previously reported in Japan, although these injuries have been documented in other countries …”

“…Balakrishnan et al . reported 20 cases of hepatic injury induced by horse kicks or falls from horses . All patients had right‐sided rib fractures, and computed tomography indicated laceration of the liver in 12 patients, contusion in three patients, and subcapsular hematoma in two patients.…”

Liver Transplantation for Hepatic Trauma

“…Nonoperative management can be implemented in 29% to 100% of patients with hepatic trauma, depending on the severity of hepatic trauma (excluding only rare cases of hepatic avulsion). [5][6][7][8][9][10] Basing on several relatively large reports, the success rate exceeds 85% to 90% 6,8,[11][12][13] and notably, failure of nonoperative management does elevate the risk of negative outcomes, 14 yet conflicting reports have also been published. 15 In patients requiring immediate operations, extensive procedures should be avoided and a damage-control strategy should be implemented.…”