Hepatic Trauma

  • James L. Patrick
  • Juliana Tobler
  • Andrew B. Peitzman
  • Biatta Sholosh
Part of the Hot Topics in Acute Care Surgery and Trauma book series (HTACST)


Injury to the liver is one of the leading causes of death from abdominal trauma and is responsible for 5% of all trauma admissions [1]. The liver’s relatively large size, fixed attachment points to the surrounding tissues, and friable parenchyma make it an easily injured organ in deceleration events such as motor vehicle accidents [2]. Because the liver occupies most of the right upper quadrant, it can be easily injured in direct blunt-force trauma or penetrating injury. The right lobe is more commonly injured because it represents most of the hepatic parenchyma, and because of its close proximity to the surrounding ribs and spine. Left hepatic lobe injuries are less common and are more likely the result of a direct blow to that region. The approximate ratio of blunt force to penetrating hepatic trauma is 3.5:1 [3].


  1. 1.
    Croce MA, et al. Nonoperative Management of Blunt Hepatic Trauma is the treatment of choice for hemodynamically stable patients results of a prospective trial. Ann Surg. 1995;221(6):744–55.CrossRefPubMedPubMedCentralGoogle Scholar
  2. 2.
    Mirvis, S.E. et al., 2014. Problem solving in Emergency Radiology., Elsevier Health Sciences.Google Scholar
  3. 3.
    Richardson JD, et al. Evolution in the Management of Hepatic Trauma: a 25-year perspective. Ann Surg. 2000;232(3):324–30.CrossRefGoogle Scholar
  4. 4.
    Ward J, Alarcon L, Peitzman AB. Management of blunt liver injury: what is new? Eur J Trauma Emerg Surg. 2015;41(3):229–37.CrossRefPubMedGoogle Scholar
  5. 5.
    Coccolini F, et al. Liver trauma: WSES position paper. World J Emerg Surg. 2015;10(1):1–10.CrossRefGoogle Scholar
  6. 6.
    Kinnunen J, et al. Emergency CT in blunt abdominal trauma of multiple injury patients. Acta Radiol. 1994;35(4):319–22.CrossRefPubMedGoogle Scholar
  7. 7.
    Boscak AR, Shanmuganathan K, Mrivis SE, et al. Optimizing trauma multidetector CT protocol for blunt splenic injury: need for arterial and venous phase scans. Radiology. 2013;268:79–88.CrossRefPubMedGoogle Scholar
  8. 8.
    Dreizin D, Munera F. Blunt polytrauma: evaluation with 64-section whole-body CT angiography. Radiographics. 2012;32(3):609–31.CrossRefPubMedGoogle Scholar
  9. 9.
    Yoon W, et al. CT in Blunt Liver Trauma. Radiographics. 2005;25(1):87–104.CrossRefPubMedGoogle Scholar
  10. 10.
    Miele V, Andreoli C, Cicco DM, et al. Hemoretroperitoneum associated with liver bare area injuries: CT evaluation. Eur Radiol. 2002;12:765–9.CrossRefPubMedGoogle Scholar
  11. 11.
    Chen WP, et al. Spectrum of transient hepatic attenuation differences in biphasic helical CT. Am J Roentgenol. 1999;172(2):419–24.CrossRefGoogle Scholar
  12. 12.
    Moore EE, Cogbill TH, Jurkovich GJ, et al. Organ injury scaling: spleen and liver (1994 revision). J Trauma Acute Care Surg. 1995;38:323–4.CrossRefGoogle Scholar
  13. 13.
    Mirvis SE, et al. Blunt hepatic trauma in adults: CT-based classification and correlation with prognosis and treatment. Radiology. 1989;171(1):27–32.CrossRefPubMedGoogle Scholar
  14. 14.
    Becker CD, et al. Blunt hepatic trauma in adults: correlation of CT injury grading with outcome. Radiology. 1996;201(1):215–20.CrossRefPubMedGoogle Scholar
  15. 15.
    Carrillo EH, et al. Interventional techniques are useful adjuncts in nonoperative management of hepatic injuries. J Trauma. 1999;46(4):619–24.CrossRefPubMedGoogle Scholar
  16. 16.
    Stassen NA, et al. Nonoperative management of blunt hepatic injury. J Trauma Acute Care Surg. 2012;73:S288–93.CrossRefPubMedGoogle Scholar
  17. 17.
    Zhang M. Bilhemia: a rare complication of transjugular intraheptic portosytemic shunt. ACG Case Rep J. 2015;3(1):60–2.CrossRefPubMedPubMedCentralGoogle Scholar
  18. 18.
    Hommes M, et al. Management of biliary complications in 412 patients with liver injuries. J Trauma Acute Care Surg. 2014;77(3):448–51.CrossRefPubMedGoogle Scholar
  19. 19.
    Mohr AM, et al. Angiographic embolization for liver injuries: low mortality, high morbidity. J Trauma Acute Care Surg. 2003;55:1077–82.CrossRefGoogle Scholar
  20. 20.
    Misselbeck TS, et al. Hepatic Angioembolization in trauma patients: indications and complications. J Trauma. 2009;67(4):769–73.CrossRefPubMedGoogle Scholar
  21. 21.
    Bauer JR, Ray CE. Transcatheter arterial embolization in the trauma patient: a review. Semin Interv Radiol. 2004;21(01):11–22.CrossRefGoogle Scholar
  22. 22.
    Lopera J. Embolization in trauma: principles and techniques. Semin Interv Radiol. 2010;27(01):014–28.CrossRefGoogle Scholar

Copyright information

© Springer International Publishing AG, part of Springer Nature 2018

Authors and Affiliations

  • James L. Patrick
    • 1
  • Juliana Tobler
    • 1
  • Andrew B. Peitzman
    • 2
  • Biatta Sholosh
    • 1
  1. 1.Abdominal Imaging Section, Department of RadiologyUniversity of Pittsburgh School of MedicinePittsburghUSA
  2. 2.Department of SurgeryUniversity of Pittsburgh School of MedicinePittsburghUSA

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