This document discusses the case of a 40-year old male who presented with injuries from a 15-foot fall, including multiple rib fractures, long bone fractures, and a grade 3-4 liver laceration. He was initially hemodynamically stable. Imaging revealed liver lacerations without arterial or venous extravasation. The patient was managed conservatively in the ICU with monitoring, blood transfusions, and stabilization of vital signs. He improved with conservative management and was discharged in a stable condition. The document also reviews criteria for and success rates of non-operative management of liver trauma.

1. LIVER TRAUMA
Dr. Niyaz Mohamed S
Institute of Digestive and Hepatobiliary
Sciences
SAKRA WORLD HOSPITAL

2. CASE CAPSULE
• 40 year old male presented with alleged H/o
fall from a height of 15 feet, sustaining
multiple injuries.
• Had multiple rib fractures with right sided
pneumothorax.
• Had multiple long bone fractures and pelvis
fracture.

3. • H/o of pain abdomen following blunt injury
abdomen.
• No Co morbidities.
• Hemodynamically stable.
• P/A- Tenderness in Right hypochondrium.
• Hemoglobin on presentation- 7.2g%.

4. • CECT abdomen done-Grade 3-4 liver
laceration with no arterial and venous
extravasation
• Minimal sub-hepatic free fluid and pelvic
extraperitoneal hematoma.

8. MANAGEMENT
• Patient hemodynamically stabilized and put
on mechanical ventillatory support due to
respiratory compromise as a result of lung
injury and pneumothorax.
• Later underwent tracheostomy.
• Then evaluation and management of liver
trauma done.

9. Management of Liver
Trauma
• Conservative management
– Monitoring of vital parameters in the ICU
– Serial hemoglobin monitoring
– Urine output
– Tranfused 2 PRBC
• Hospital Course
– Patient remained hemodynamically stable,
– no fall in hemoglobin
– Abdominal distension decreased and oral feeds started
• Patient improved and was discharged in a stable state

10. DPL CECT
Surgical treatment Non-operative treatment
World War II – 1965 Post 1965;1981

11. Non-operative
Management (NOM)
• 50-80% of liver injuries stop bleeding
spontaneously
Patient selection criteria:
Hemodynamically stable
Absence of peritoneal signs
Presence of neurologic integrity
No associated intra-abdominal injuries
Limited hemoperitoneum (125-250 ml)

12. Non-operative
Management
Prerequisites for non-operative treatment:
– Good quality CT scan
– Experienced radiologist
– Ability to monitor patients in the ICU setting
– Feasibility of immediate surgery if warranted
(experienced liver surgeons)

13. Results of NOM
Author N NOM% Success% Transfusions Mortality
Meredith 70 55 97 5.4 9
Croce 136 82 89 2.4 8
Brasel 82 61 96 6.1 -
Malhotra 661 85 92.5 4.4 7.9

14. THANK YOU