Liver Trauma

The liver is the most frequently injured abdominal organ. Abdominal injuries occur in 31% of patients of polytrauma with 13 and 16% spleen and liver injuries respectively, and pelvic injuries in 28% of cases, making differential diagnosis between pelvic or intractable abdominal injury difficult.[1] Liver trauma is the most common cause of death after abdominal injury. The most common cause of liver injury is blunt abdominal trauma. Identification of serious intra-abdominal trauma is often challenging; many injuries may not manifest during the initial assessment and treatment period. Liver frequently injured following abdominal trauma and associated injuries contribute significantly to mortality and morbidity, and may mask the liver injury and causes delay in diagnosis. Management of hepatic injuries has evolved over the past 30 years. Prior to that time, a diagnostic peritoneal lavage (DPL) positive for blood, was an indication for exploratory celiotomy because of concern about ongoing hemorrhage and/or missed intra-abdominal injuries needing repair. The recognition that between 50 and 80 per cent of liver injuries stop bleeding spontaneously, coupled with better imaging of the injured liver by computed tomography (CT) and efficient ICU management, has led progressively to the acceptance of nonoperative management (NOM) with a resultant decrease in mortality rates