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Frontiers of Medicine

ISSN 2095-0217

ISSN 2095-0225(Online)

CN 11-5983/R

Postal Subscription Code 80-967

2018 Impact Factor: 1.847

Front Med    2012, Vol. 6 Issue (3) : 225-233     DOI: 10.1007/s11684-012-0186-6
REVIEW |
Emergency strategies and trends in the management of liver trauma
Hongchi Jiang1,2, Jizhou Wang1,2()
1. Department of Hepatic Surgery, the First Affiliated Hospital of Harbin Medical University, Harbin 150001, China; 2. Key Laboratory of Hepatosplenic Surgery, the First Affiliated Hospital of Harbin Medical University, Harbin 150001, China
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Abstract  

The liver is the most frequently injured organ during abdominal trauma. The management of hepatic trauma has undergone a paradigm shift over the past several decades, with mandatory operation giving way to nonoperative treatment. Better understanding of the mechanisms and grade of liver injury aids in the initial assessment and establishment of a management strategy. Hemodynamically unstable patients should undergo focused abdominal sonography for trauma, whereas stable patients may undergo computed tomography, the standard examination protocol. The grade of liver injury alone does not accurately predict the need for operation, and nonoperative management is rapidly becoming popular for high-grade injuries. Hemodynamic instability with positive focused abdominal sonography for trauma and peritonitis is an indicator of the need for emergent operative intervention. The damage control concept is appropriate for the treatment of major liver injuries and is associated with significant survival advantages compared with traditional prolonged surgical techniques. Although surgical intervention for hepatic trauma is not as common now as it was in the past, current trauma surgeons should be familiar with the emergency surgical skills necessary to manage complex hepatic injuries, such as packing, Pringle maneuver, selective vessel ligation, resectional debridement, and parenchymal sutures. The present review presents emergency strategies and trends in the management of liver trauma.

Keywords liver trauma      nonoperative management      operative management     
Corresponding Authors: Wang Jizhou,Email:wangjizhou1984@hotmail.com   
Issue Date: 05 September 2012
URL:  
http://academic.hep.com.cn/fmd/EN/10.1007/s11684-012-0186-6     OR     http://academic.hep.com.cn/fmd/EN/Y2012/V6/I3/225
GradeDescription of injury
IHematoma: subcapsular, nonexpanding,<10% surface areaLaceration: capsular tear, nonbleeding,<1 cm in parenchymal depth
IIHematoma: subcapsular, 10%–50% surface area; intraparenchymal,<10 cm in diameterLaceration: 1–3 cm in parenchymal depth,<10 cm in length
IIIHematoma: subcapsular,>50% surface area or expanding. Ruptured subcapsular or parenchymal hematoma. Intraparenchymal,>10 cm or expandingLaceration:>3 cm in parenchymal depth
IVHematoma: ruptured intraparenchymal hematoma with active bleedingLaceration: parenchymal disruption involving 25%–75% of a hepatic lobe or one to three Couinaud segments within a single lobe
VLaceration: parenchymal disruption involving>75% of a hepatic lobe or more than three Couinaud segments within a single lobeVascular: juxtahepatic venous injuries (i.e. retrohepatic vena cava or central major hepatic veins)
VIVascular: hepatic avulsion
Tab.1  American Association for the Surgery of Trauma liver injury scale
Fig.1  Schematics for the diagnosis of liver trauma. FAST, focused abdominal sonography for trauma; CT, computed tomography.
Fig.2  A computed tomography scan of a blunt liver trauma.
Fig.3  Schematics for management of hemostasis. ICU, intensive care unit.
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