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The Shock Trauma Manual of Operative Techniques pp 197–224Cite as

Liver Injuries

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Abstract

The liver is the largest organ in the abdomen and is frequently injured. Although minor or moderate injuries can be managed with simple observation, the extensive vascular supply of the liver makes severe liver injuries extremely challenging. Frequently, patients who require liver-specific operations have exsanguinating hemorrhage. Despite improvements in resuscitation, mortality of operative liver injuries remains approximately 50 %, with mortality of up to 80 % for patients with juxtahepatic venous injuries. Morbidity rates following operation for high-grade liver injuries are as high as 30–80 % depending on the grade of injury and types of complications.

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References

  1. Polanco PM, Brown JB, Puyana JC, et al. The swinging pendulum: a national perspective of nonoperative management in severe blunt liver injury. J Trauma Acute Care Surg. 2013;75(4):590.

    Article  PubMed  Google Scholar 

  2. Lin B-C, Fang J-F, Chen R-J, Wong Y-P. Surgical management and outcome of blunt major liver injuries: experience of damage control laparotomy with perihepatic packing in one trauma centre. Injury 2013;45:122. http://dx.doi.org/10.1016/j.injury.2013.08.022

  3. Fabian TC, Croce MA, Stanford GG, et al. Factors affecting morbidity following hepatic trauma: a prospective analysis of 482 injuries. Ann Surg. 1991;213:540–8.

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  4. Asensio JA, Roldan G, Petrone P, et al. Operative management and outcomes in 103 AAST-OIS grades IV and V complex hepatic injuries; trauma surgeons still need to operate, but angioembolization helps. J Trauma. 2003;54:647–54.

    Article  PubMed  Google Scholar 

  5. Denton JR, Moore EE, Coldwell DM. Multimodality treatment for grade V hepatic injuries: perihepatic packing, arterial embolization, and venous stent. J Trauma. 1997;42:964–8.

    Article  CAS  PubMed  Google Scholar 

  6. Cogbill TH, Moore EE, Jurkovich GJ, et al. Severe hepatic trauma: a multicenter experience with 1335 liver injuries. J Trauma. 1988;28:1433–8.

    Article  CAS  PubMed  Google Scholar 

  7. Polanco P, Leon S, Pineda J, et al. Hepatic resection in the management of complex injury to the liver. J Trauma. 2008;65:1264–70.

    Article  PubMed  Google Scholar 

  8. Petri SL, Gruttadauria S, Pagano D, et al. Surgical management of complex liver trauma: a single liver transplant center experience. Am Surg. 2012;78:20–5.

    Google Scholar 

  9. Dabbs DN, Stein DM, Scalea TM. Major hepatic necrosis: a common complication after angioembolization for treatment of high-grade liver injuries. J Trauma. 2009;66:621–9.

    Article  PubMed  Google Scholar 

  10. Letoublon C, Morra I, Chen Y, et al. Hepatic arterial embolization in the management of blunt hepatic trauma: indications and complications. J Trauma. 2011;70(5):1032.

    Article  PubMed  Google Scholar 

  11. Pringle JH. V. Notes on the arrest of hepatic hemorrhage due to trauma. Ann Surg. 1908;48(4):541–9.

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  12. Schwab CW. Selection of nonoperative management candidates. World J Surg. 2001;25:1389–92.

    CAS  PubMed  Google Scholar 

  13. Hawkins ML, Wynn JJ, Schmacht DC, et al. Nonoperative management of liver and/or splenic injuries: effect on resident surgical experience. Am Surg. 1998;64:552–7.

    CAS  PubMed  Google Scholar 

  14. Rutledge R, Hunt JP, Lentz CW, et al. A Statewide, population-based time-series analysis of the increasing frequency of non-operative management of abdominal solid organ injury. Ann Surg. 1995;225:311–26.

    Article  Google Scholar 

  15. Shedden K. Cut Gurlt. Geschichte de Chir. 1898;3722.

    Google Scholar 

  16. Tilton BJ. Considerations regarding wounds of the liver. Ann Surg. 1905;61:20–30.

    Article  Google Scholar 

  17. Krieg EG. Hepatic trauma: analysis of sixty cases. Arch Surg. 1936;32:907–14.

    Article  Google Scholar 

  18. Lamb CA. Rupture of the liver. N Engl J Med. 1939;221:855–9.

    Article  Google Scholar 

  19. Beck C. Surgery of the liver. JAMA. 1902;38:1063–8.

    Article  Google Scholar 

  20. Trunkey DD. Hepatic trauma: contemporary management. Surg Clin N Am. 2004;84:437–50.

    Article  PubMed  Google Scholar 

  21. Root HD, Howser CW, McKinley CR, et al. Diagnostic peritoneal lavage. Surgery. 1965;57:633–7.

    CAS  PubMed  Google Scholar 

  22. Federle MP, Goldberg HI, Kaiser KA, et al. Evaluation of abdominal trauma by computed tomography. Radiology. 1981;138:a637–44.

    Article  Google Scholar 

  23. Moore EE, Shackford SR, Pachter HL, et al. Organ injury scaling: spleen, liver and kidney. J Trauma. 1989;29:1664–5.

    Article  CAS  PubMed  Google Scholar 

  24. Moore EE, Shackford SR, Pachter HL, et al. Organ injury scaling: spleen, liver and kidney. J Trauma. 1995;38:323–4.

    Article  CAS  PubMed  Google Scholar 

  25. Croce MA, Fabian TC, Menke PG, 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;221:744–55.

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  26. Pachter HL, Knudson MM, Esrig B, et al. Status of nonoperative management of blunt hepatic injuries in 1995: a multicenter experience with 404 patients. J Trauma. 1995;40:31–8.

    Article  Google Scholar 

  27. Velmahos GC, Toutouzas K, Radin R, et al. High success with nonoperative management of blunt hepatic trauma: the liver is a sturdy organ. Arch Surg. 2003;138:475–81.

    Article  PubMed  Google Scholar 

  28. Gao J, Du D, Zhao X, et al. Liver trauma: experience in 348 cases. World J Surg. 2003;27:703–8.

    Article  PubMed  Google Scholar 

  29. Meredith JW, Young JS, Bowling J, Roboussin D. Nonoperative management of blunt hepatic trauma: exception or the rule? J Trauma. 1994;36:529–35.

    Article  CAS  PubMed  Google Scholar 

  30. Stassen NA, Bhullar I, Cheng JD, et al. Nonoperative management of blunt hepatic injury: an Eastern Association for the surgery of trauma practice management guideline. J Trauma Acute Care Surg. 2012;73(5):4.

    Google Scholar 

  31. Couinaud C. Le foie: études anatomiques et chirurgicales [The liver: anatomical and surgical studies] (in French). Paris: Masson; 1957.

    Google Scholar 

  32. Hiatt JR, Gabbay J, Busuttil RW. Surgical anatomy of the hepatic arteries in 1000 cases. Ann Surg. 1994;220(1):50–2.

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  33. Baumgartner F, Scudamore C, Nair C, et al. Venovenous bypass for hepatic and caval trauma. J Trauma. 1995;39:671–3.

    Article  CAS  PubMed  Google Scholar 

  34. Horowitz JR, Black T, Lally KP, Andrassy RJ. Venovenous bypass as an adjunct for the management of a retrohepatic venous injury in child. J Trauma. 1995;39:584–5.

    Article  Google Scholar 

  35. Schrock T, Blaisdell FW, Mathewson C. Management of blunt trauma to the liver and hepatic veins. Arch Surg. 1968;96:698–704.

    Article  CAS  PubMed  Google Scholar 

  36. Burch JM, Feliciano DV, Mattox KL. The atriocaval shunt. Facts and fiction. Ann Surg. 1988;207(5):555–68.

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  37. Kudsk KA, Sheldon GF, Lim RC. Atrial-caval shunting (ACS) after trauma. J Trauma. 1982;22(2):81–5.

    Article  CAS  PubMed  Google Scholar 

  38. Pachter HL, Spencer FC, Hofstetter SL, et al. The management of juxtahepatic venous injuries without an atriocaval shunt. Surgery. 1986;99:569–75.

    CAS  PubMed  Google Scholar 

  39. Peitzman AB, Marsh JW. Advanced operative techniques in the management of complex liver injury. J Trauma Acute Care Surg. 2012;73(3):765.

    Article  PubMed  Google Scholar 

  40. Dabbs DN, Stein DM, Philosophe B, Scalea TM. Treatment of major hepatic necrosis: lobectomy versus serial debridement. J Trauma. 2010;69(3):562.

    Article  PubMed  Google Scholar 

  41. Morimoto R, Bironlini D, Junqueria A, Poqqetti R, Horita L. Balloon tamponade for transfixing lesion of the liver. Surg Gynecol Obstet. 1987;164:87.

    CAS  PubMed  Google Scholar 

  42. Poggetti RS, Moore EE, Moore FA, Mitchell MB, Read RA. Balloon tamponade for bilobar transfixing hepatic gunshot wounds. J Trauma. 1992;33(5):694.

    Article  CAS  PubMed  Google Scholar 

  43. Seligman JY, Egan M. Balloon tamponade: an alternative in the treatment of liver trauma. Am Surg. 1997;63(11):1022–3.

    CAS  PubMed  Google Scholar 

  44. Kozar RA, McNutt MK. Management of adult blunt hepatic trauma. Curr Opin Crit Care. 2010;16:596–601.

    Article  PubMed  Google Scholar 

  45. Misselbeck TS, Teicher E, Cipolle M, et al. Hepatic angioembolization in trauma patients: indications and complications. J Trauma. 2009;67:769–73.

    Article  PubMed  Google Scholar 

  46. Johnson JW, Gracias VH, Gupta R, et al. Hepatic angiography in patients undergoing damage control laparotomy. J Trauma. 2002;52:1102–6.

    Article  PubMed  Google Scholar 

  47. Denton JR, Moore EE, Coldwell DM. Multimodality treatment of grade v hepatic injuries: perihepatic packing, arterial embolization, and venous stenting. J Trauma. 1997;42:965–8.

    Article  Google Scholar 

  48. Asensio JA, Petrone P, Garcia-Nunez L, Kimbrell B, Kuncir E. Multidisciplinary approach for the management of complex hepatic injuries AAST-OIS grades IV-V: a prospective study. Scand J Surg. 2007;96:214–20.

    CAS  PubMed  Google Scholar 

  49. Wahl WL, Ahrns KS, Brandt MM, Franklin GA, Taheri PA. The need for early angiographic embolization in blunt liver injuries. J Trauma. 2002;52:1097–101.

    Article  PubMed  Google Scholar 

  50. Mohr AM, Lavery RF, Barone A, et al. Angiographic embolization for liver injuries: low mortality, high morbidity. J Trauma. 2003;55:1077–81.

    Article  PubMed  Google Scholar 

  51. Henry SM, Duncan AO, Scalea TM. Intestinal Allis clamps as temporary vascular control for major retroperitoneal venous injury. J Trauma. 2001;51(1):170–2.

    Article  CAS  PubMed  Google Scholar 

  52. Heuer M, et al. Transplantation after blunt trauma to the liver: a valuable option or just a “waste of organs”? Eur J Med Res. 2010;15(4):169–73.

    Article  PubMed Central  PubMed  Google Scholar 

  53. Tucker ON, Marriott P, Rela M, Heaton N. Emergency liver transplantation following severe liver trauma. Liver Transpl. 2008;14:1204–10.

    Article  PubMed  Google Scholar 

  54. Liu PP, Chen CL, Cheng YF, et al. Use of a refined operative strategy in combination with the multidisciplinary approach to manage blunt juxtahepatic venous injuries. J Trauma. 2005;59:940–5.

    Article  CAS  PubMed  Google Scholar 

  55. Wahl WL, Brandt MM, Hemmila MR, Arbabi S. Diagnosis and management of bile leaks after blunt liver injury. Surgery. 2005;138(4):742–8.

    Article  PubMed  Google Scholar 

  56. Anand RJ, Ferrada PA, Darwin PE, Bochicchio GV, Scalea TM. Endoscopic retrograde cholangiopancreatography is an effective treatment for bile leak after severe liver trauma. J Trauma. 2011;71(2):480–5.

    Article  PubMed  Google Scholar 

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Authors and Affiliations

  1. Trauma and Critical Care, R Adams Cowley Shock Trauma Center, Baltimore, MD, USA

    Deborah M. Stein M.D., M.P.H.

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  1. Deborah M. Stein M.D., M.P.H.
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Editors and Affiliations

  1. Department of Trauma, R Adams Cowley Shock Trauma Center, Baltimore, Maryland, USA

    Thomas M. Scalea

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Stein, D.M. (2015). Liver Injuries. In: Scalea, T. (eds) The Shock Trauma Manual of Operative Techniques. Springer, New York, NY. https://doi.org/10.1007/978-1-4939-2371-7_11

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  • DOI: https://doi.org/10.1007/978-1-4939-2371-7_11

  • Publisher Name: Springer, New York, NY

  • Print ISBN: 978-1-4939-2370-0

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