LIVER TRAUMA

Dr. Niyaz Mohamed SInstitute of Digestive and Hepatobiliary

SciencesSAKRA WORLD HOSPITAL

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.

• 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%.

• CECT abdomen done-Grade 3-4 liver laceration with no arterial and venous extravasation

• Minimal sub-hepatic free fluid and pelvic extraperitoneal hematoma.

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.

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

Surgical treatment Non-operative treatment

World War II – 1965 Post 1965;1981

DPL CECT

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)

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)

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

THANK YOU