Blunt liver trauma: a new concept for classification of liver trauma based on vessel injury.
We reviewed a consecutive 143 cases of blunt liver trauma, 43 children and 100 adults, to clarify the pathosis of liver trauma and to reasonably select treatment, non-operative or operative management. The primary determinant in the prognosis of liver trauma was clearly hemorrhage due to vessel injuries and its main treatment method was hemostasis. We developed a new concept for the classification of blunt liver trauma based on vessel injuries: I = subcapsular Glissonian vessel injuries, II = transcapsular Glissonian vessel injuries and III = in-/out-flow vessel injuries and 3 basic types were divided into 2 subtypes, respectively. Distribution of liver trauma according to the present classification was as follows: type I = 23% in child cases and 22% in adult cases, type II = 65% and 64% and type III = 12% and 14%, respectively. The main management was non-operative for type I, minor or major surgery for type II, and extended surgery for type III. The analysis of dead cases showed the following: I = 0% in child cases and 6% in adult, II = 60% and 55%; III = 40% and 39%, respectively. The first direct cause was hemorrhage: 60% in child cases and 49% in adult. The present classification was applicable for both child and adult patients, and presented a selection of management for liver trauma, suggesting the prognosis.
Namieno
T
T
First Department of Surgery, Hokkaido University Hospital, Sapporo, Japan.
Hata
Y
Y
Uchino
J
J
Matsubara
I
I
Tedo
I
I
D000328:Adult; D002648:Child; D002675:Child, Preschool; D005260:Female; D006470:Hemorrhage / Q000601:surgery; D006488:Hemostasis, Surgical; D006801:Humans; D008099:Liver / Q000098:blood supply / Q000293:injuries*; D008107:Liver Diseases / Q000601:surgery; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D012189:Retrospective Studies; D014949:Wounds, Nonpenetrating / Q000145:classification* / Q000401:mortality