2. INTRODUCTION
• It is the 2nd commonest organ injured in blunt abdominal
trauma and the commonest injured in penetrating trauma.
• 1% - 8% of patient with multiple blunt trauma sustain a liver
injury.
3. FACTORS
• The large size of the liver
• Its friable parenchyma
• Its thin capsule
• Its relatively fixed position in relation to the spine and ribs
5. CLASSIFICATION
I - Close Injury
1. According to mechanism of injury:
Direct hit, fall from a height, compression between two objects, Road traffic injuries
2. According to the type of damage:
rupture of the liver with damage of the capsule subcapsular hematoma, damage of
extrahepatic bile ducts and blood vessels of the liver
3. According to the degree of damage:
surface cracks and rupture to a depth of 2 cm, rupture to half thickness of the liver,
rupture depth of more than half of the liver
4. Localization:
Damage lobes or segments of the liver.
5. Character:
With damage of extra- and intrahepatic vessels and bile ducts.
6. II - Open Injury
1. Gunshot: bullet, shrapnel, the shot.
2. Machetes: stab
III - The combination of blunt trauma injury to the liver
9. GRADING OUTCOMES
• Grade I,II
- minor injuries, represent 80-90% of all injuries, require
minimal or no operative treatment
• Grade III-V
- severe,require surgical intervention
• Grade VI
- incompatible with survival
10. CLINICAL PICTURE
• Pain
• Signs of blood loss
• Hematoma
• Tenderness upon palpation
• Dullness during percussion
11. DIAGNOSTICS
Ultrasonography
- fast, accurate, noninvasive, a good initial screening test
- sensitivity 88 %, specificity 99 %
DPL
- fast, sensitive, accurate and simple to perform
- invasive, cannot diagnose retroperitoneal injury
Computed tomography
- The standard evaluation method for stable patient . Performed with
dilute water soluble oral contrast agent and intravenous contrast
X-ray
- nonspecific, but useful in showing the extent of associated skeletal
trauma.
18. MANAGEMENT
CONSERVATIVE :
1. 86% of liver injuries stopped bleeding by the time of surgical
exploration
2. 67% of operations performed are nontherapeutic
19. • Criteria
- hemodynamically stable
- simple hepatic parenchyma laceration of intrahepatic
hematoma
- absence of active hemorrhage
- hemoperitoneum of less than 500ml
- limited need for liver related blood transfusions (12U)
- absence of peritoneal sign
- absence of other peritoneal injuries that would otherwise
require an operation
21. • Hepatotomy with direct suture ligation
- using the finger fracture technique, electrocautery or an
ultrasonic dissector to expose damaged vessels and hepatic
duct which ligated , clipped or repaired
- low incidence of rebleeding, necrosis and sepsis
- effectives following blunt liver trauma requires further
evaluation
22. • Resection debridement
- removal devitalized tissue
- rapid compared with standard anatomical resection, which
are more time consuming and remove more normal liver
parenchyma
- reduced risk of post-op sepsis secondary hemorrhage and bile
leakage
23. • Anatomical resection
- reserved for deep laceration involving major vessels or bile
ducts, extensive devascularization and major hepatic venous
bleeding
• Perihepatic packing
- Indication:
coagulopathy, irreversible shock from blood loss (10u),
hypothermia(32C), acidosis(PH7.2), bilobar injury,large
nonexpanding hematoma, capsular avulsion, vena cava or
hepatic vein injuries
24.
25. • Mesh rapping
- new technique for grade III,IV laceration, tamponading large
intrahepatic hematomas
- not indicated where juxtacaval or hepatic vein injury is
suspected
