Management of liver trauma.
METHODS
Management of blunt or penetrating injuries to the liver remains a significant challenge. This review discusses the mechanisms of liver injury, grading system for severity, available diagnostic modalities and current management options. It is based on a Medline literature search and the authors' clinical experience.


RESULTS
Unstable patients require immediate laparotomy, but selected patients who are haemo- dynamically stable may be managed without operation. The preferred operative techniques include resectional debridement, hepatotomy with direct suture ligation and perihepatic packing; anatomical resection, hepatic artery ligation and various bypass techniques have a limited, more defined role for selected injuries. Major complications include haemorrhage, sepsis and bile leak.


CONCLUSIONS
Enhanced resuscitation, anaesthesia and intensive care have contributed to a significant reduction in mortality rates from liver trauma. Optimum results are obtained with a specialist team that includes an experienced liver surgeon, anaesthetist, endoscopist and interventional hepatobiliary radiologist with expertise in managing postoperative complications.
Parks
R W
RW
Surgical Unit, Mater Hospital, Belfast, UK.
Chrysos
E
E
Diamond
T
T
D006801:Humans; D015601:Injury Severity Score; D008099:Liver / Q000293:injuries*; D011183:Postoperative Complications / Q000209:etiology; D013526:Surgical Mesh; D014057:Tomography, X-Ray Computed; D014949:Wounds, Nonpenetrating / Q000175:diagnosis / Q000601:surgery / Q000628:therapy*; D014950:Wounds, Penetrating / Q000175:diagnosis / Q000601:surgery / Q000628:therapy*