The Management of Liver Trauma

  • A. B. Cresswell
  • M. J. Bowles
  • J. A. Wendon


The adult liver weighs around 1500 g and lies mainly in the right upper quadrant of the abdomen, immediately beneath the diaphragm [1]. The liver is the most commonly injured intra-abdominal organ and is found to be damaged in 30% of patients undergoing laparotomy for penetrating injuries and in 15–20% of laparotomies for blunt injuries [2].


Liver Injury Hepatic Artery Inferior Vena Cava Hepatic Vein Bile Leak 


Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.


  1. 1.
    Hall-Craggs ECB (1990) Anatomy as a Basis for Clinical Medicine, 2nd edn. Williams & Wilkins, Philadelphia.Google Scholar
  2. 2.
    Feliciano DV (1989) Surgery for liver trauma. Surg Clin North Am 69:273–284PubMedGoogle Scholar
  3. 3.
    Couinaud C (1954) Lobes et segments hepatiques: note sur l’architecture anatomique et chirugicale du foie. Presse Med 62:709–712PubMedGoogle Scholar
  4. 4.
    Parks RW, Chrysos E, Diamond T (1999) Management of liver trauma. Br J Surg 86:1121–1135PubMedCrossRefGoogle Scholar
  5. 5.
    John TG, Greig JD, Johnstone AJ, Garden OJ (1992) Liver trauma: a 10-year experience. Br J Surg 79:1352–1356PubMedCrossRefGoogle Scholar
  6. 6.
    Schweizer W, Tanner S, Baer HU, et al (1993) Management of traumatic liver injuries. Br J Surg 80:86–88PubMedCrossRefGoogle Scholar
  7. 7.
    Toro K, Hubay M, Sotonyi P, Keller E (2005) Fatal traffic injuries among pedestrians, bicyclists and motor vehicle occupants. Forensic Sci Int 151:151–156PubMedCrossRefGoogle Scholar
  8. 8.
    Feliciano DV, Mattox KL, Jordan GL Jr, Burch JM, Bitondo CG, Cruse PA (1986) Management of 1000 consecutive cases of hepatic trauma (1979–1984). Ann Surg 204:438–445PubMedCrossRefGoogle Scholar
  9. 9.
    Krige JE, Bornman PC, Terblanche J (1997) Liver trauma in 446 patients. S Afr J Surg 35:10–15PubMedGoogle Scholar
  10. 10.
    Garden OJ (2005) Hepatobiliary and Pancreatic Surgery. A Companion to Specialist Surgical Practice. Elsevier Saunders, St LouisGoogle Scholar
  11. 11.
    Moore EE, Cogbill TH, Jurkovich GJ, Shackford SR, Malangoni MA, Champion HR (1995) Organ injury scaling: spleen and liver (1994 revision). J Trauma 38:323–324PubMedGoogle Scholar
  12. 12.
    Moore EE, Shackford SR, Pachter HL, et al (1989) Organ injury scaling: spleen, liver, and kidney. J Trauma 29:1664–1666PubMedGoogle Scholar
  13. 13.
    Ochsner MG, Jaffin JH, Golocovsky M, Jones RC (1993) Major hepatic trauma. Surg Clin North Am 73:337–352PubMedGoogle Scholar
  14. 14.
    American College of Surgeons (2004) Advanced Trauma Life Support Manual, 7th edn. American College of Surgeons, ChicagoGoogle Scholar
  15. 15.
    Krausz MM (2006) Initial resuscitation of hemorrhagic shock. World J Emerg Surg 1:14PubMedCrossRefGoogle Scholar
  16. 16.
    Bickell WH, Wall MJ Jr, Pepe PE, et al (1994) Immediate versus delayed fluid resuscitation for hypotensive patients with penetrating torso injuries. N Engl J Med 331:1105–1109PubMedCrossRefGoogle Scholar
  17. 17.
    Scollay JM, Beard D, Smith R, McKeown D, Garden OJ, Parks R (2005) Eleven years of liver trauma: the Scottish experience. World J Surg 29:744–749PubMedCrossRefGoogle Scholar
  18. 18.
    Wilson RH, Moorehead RJ (1991) Hepatic trauma and its management. Injury 22:439–445PubMedCrossRefGoogle Scholar
  19. 19.
    McKenney MG, Martin L, Lentz K, et al (1996) 1,000 consecutive ultrasounds for blunt abdominal trauma. J Trauma 40:607–610PubMedGoogle Scholar
  20. 20.
    Toombs BD, Sandier CM, Rauschkolb EN, Strax R, Harle TS (1982) Assessment of hepatic injuries with computed tomography. J Comput Assist Tomogr 6:72–75PubMedCrossRefGoogle Scholar
  21. 21.
    Yoon W, Jeong YY, Kim JK, et al (2005) CT in blunt liver trauma. Radiographics 25:87–104PubMedCrossRefGoogle Scholar
  22. 22.
    Croce MA, Fabian TC, Kudsk KA, et al (1991) AAST organ injury scale: correlation of CT-graded liver injuries and operative findings. J Trauma 31:806–812PubMedCrossRefGoogle Scholar
  23. 23.
    Fang JF, Chen RJ, Wong YC, et al (1998) Pooling of contrast material on computed tomography mandates aggressive management of blunt hepatic injury. Am J Surg 176:315–319PubMedCrossRefGoogle Scholar
  24. 24.
    Yokota J, Sugimoto T (1994) Clinical significance of periportal tracking on computed tomographic scan in patients with blunt liver trauma. Am J Surg 168:247–250PubMedCrossRefGoogle Scholar
  25. 25.
    MacLean AA, Durso A, Cohn SM, Cameron J, Munera F (2005) A clinically relevant liver injury grading system by CT, preliminary report. Emerg Radiol 12:34–37PubMedCrossRefGoogle Scholar
  26. 26.
    Croce MA, Fabian TC, Menke PG, et al (1995) Nonoperative management of blunt hepatic trauma is the treatment of choice for hemodynamically stable patients. Results of a prospective trial. Ann Surg 221:744–753Google Scholar
  27. 27.
    Sharma OP, Oswanski MF, Singer D, Raj SS, Daoud YA (2005) Assessment of nonoperative management of blunt spleen and liver trauma. Am Surg 71:379–386PubMedGoogle Scholar
  28. 28.
    Nance ML, Peden GW, Shapiro MB, Kauder DR, Rotondo MF, Schwab CW (1997) Solid viscus injury predicts major hollow viscus injury in blunt abdominal trauma. J Trauma 43:618–622PubMedCrossRefGoogle Scholar
  29. 29.
    Moore AF, Hargest R, Martin M, Delicata RJ (2004) Intra-abdominal hypertension and the abdominal compartment syndrome. Br J Surg 91:1102–1110PubMedCrossRefGoogle Scholar
  30. 30.
    Landau A, van As AB, Numanoglu A, Millar AJ, Rode H (2006) Liver injuries in children: the role of selective non-operative management. Injury 37:66–71PubMedCrossRefGoogle Scholar
  31. 31.
    Feliciano DV (1992) Continuing evolution in the approach to severe liver trauma. Ann Surg 216:521–523PubMedGoogle Scholar
  32. 32.
    Sherman HF, Savage BA, Jones LM, et al (1994) Nonoperative management of blunt hepatic injuries: safe at any grade? J Trauma 37:616–621PubMedGoogle Scholar
  33. 33.
    Pachter HL, Knudson MM, Esrig B, et al (1996) Status of nonoperative management of blunt hepatic injuries in 1995: a multicenter experience with 404 patients. J Trauma 40:31–38PubMedGoogle Scholar
  34. 34.
    Demetriades D, Karaiskakis M, Alo K, Velmahos G, Murray J, Asensio J (2003) Role of post operative computed tomography in patients with severe liver injury. Br J Surg 90:1398–1400PubMedCrossRefGoogle Scholar
  35. 35.
    Laopaiboon V, Aphinives C, Pugkem A, Thummaroj J, Puttharak W, Soommart Y (2006) Selective transcatheter embolization for treatment of post-traumatic hepatic artery and portal vein pseudoaneurysms. J Med Assoc Thai 89:248–252PubMedGoogle Scholar
  36. 36.
    Lubezky N, Konikoff FM, Rosin D, Carmon E, Kluger Y, Ben-Haim M (2006) Endoscopic sphincterotomy and temporary internal stenting for bile leaks following complex hepatic trauma. Br J Surg 93:78–81PubMedCrossRefGoogle Scholar
  37. 37.
    MacKenzie S, Kortbeek JB, Mulloy R, Hameed SM (2004) Recent experiences with a multidisciplinary approach to complex hepatic trauma. Injury 35:869–877PubMedCrossRefGoogle Scholar
  38. 38.
    Calne RY, McMaster P, Pentlow BD (1979) The treatment of major liver trauma by primary packing with transfer of the patient for definitive treatment. Br J Surg 66:338–339PubMedCrossRefGoogle Scholar
  39. 39.
    Dawson DL, Johansen KH, Jurkovich GJ (1991) Injuries to the portal triad. Am J Surg 161:545–551PubMedCrossRefGoogle Scholar
  40. 40.
    Borowicz MR, Adams DB, Simpson JP, Cunningham JT (1995) Management of biliary strictures due to laparoscopic cholecystectomy. J Surg Res 58:86–89PubMedCrossRefGoogle Scholar
  41. 41.
    Krige JE, Bornman PC, Terblanche J (1992) Therapeutic perihepatic packing in complex liver trauma. Br J Surg 79:43–46PubMedCrossRefGoogle Scholar
  42. 42.
    Postema RR, ten Kate FJ, Terpstra OT (1993) Less hepatic tissue necrosis after argon beam coagulation than after conventional electrocoagulation. Surg Gynecol Obstet 176:177–180PubMedGoogle Scholar
  43. 43.
    Dixon E, Vollmer CM Jr, Bathe OF, Sutherland F (2005) Vascular occlusion to decrease blood loss during hepatic resection. Am J Surg 190:75–86PubMedCrossRefGoogle Scholar
  44. 44.
    Watson CJ, Calne RY, Padhani AR, Dixon AK (1991) Surgical restraint in the management of liver trauma. Br J Surg 78:1071–1075PubMedCrossRefGoogle Scholar
  45. 45.
    Hollands MJ, Little JM (1990) The role of hepatic resection in the management of blunt liver trauma. World J Surg 14:478–482PubMedCrossRefGoogle Scholar
  46. 46.
    Strong RW, Lynch SV, Wall DR, Liu CL (1998) Anatomic resection for severe liver trauma. Surgery 123:251–257PubMedGoogle Scholar
  47. 47.
    Mohr AM, Lavery RF, Barone A, et al (2003) Angiographic embolization for liver injuries: low mortality, high morbidity. J Trauma 55:1077–1081PubMedGoogle Scholar
  48. 48.
    Erdogan D, Busch OR, van Delden OM, Ten Kate FJ, Gouma DJ, van Gulik TM (2006) Man agement of spontaneous haemorrhage and rupture of hepatocellular adenomas. A single centre experience. Liver Int 26:433–438Google Scholar
  49. 49.
    Flint LM Jr, Polk HC Jr (1979) Selective hepatic artery ligation: limitations and failures. J Trauma 19:319–323PubMedCrossRefGoogle Scholar
  50. 50.
    Liu PP, Chen CL, Cheng YF, et al (2005) Use of a refined operative strategy in combination with the multidisciplinary approach to manage blunt juxtahepatic venous injuries. J Trauma 59:940–945PubMedGoogle Scholar
  51. 51.
    Chen RJ, Fang JF, Lin BC, Jeng LB, Chen MF (1995) Surgical management of juxtahepatic venous injuries in blunt hepatic trauma. J Trauma 38:886–890PubMedGoogle Scholar
  52. 52.
    Ringe B, Pichlmayr R (1995) Total hepatectomy and liver transplantation: a life-saving procedure in patients with severe hepatic trauma. Br J Surg 82:837–839PubMedCrossRefGoogle Scholar

Copyright information

© Springer Science + Business Media Inc. 2007

Authors and Affiliations

  • A. B. Cresswell
    • 1
  • M. J. Bowles
    • 1
  • J. A. Wendon
    • 2
  1. 1.Liver Transplant Surgical Service, Institute of Liver StudiesKing’s College Hospital Denmark HillLondonUSA
  2. 2.Institute of Liver StudiesKing’s College Hospital Denmark HillLondonUSA

Personalised recommendations