[Treatment of blunt trauma to the liver].
Management of Blunt hepatic injuries is dramatically modified since early 80's. Non operative management is presently used in over 80% of all cases, irrespective of haemoperitoneum and grade of injury. Close observation of the patient is requested. Laparotomy or laparoscopy must be decided in any case of suspected missed injury. Laparotomy is used for worse hemodynamic status. Peroperative mortality is mainly attributed to haemorrhage. Aggressive surgery has progressively given place to more conservative techniques. Understanding of coagulopathy related to massive transfusions, acidosis and hypothermia led to enhance efficacy of manual compression of the injured liver and of perihepatic packing and planned reoperation. In survivors this abbreviated laparotomy has pitfalls and complications which must be known, mainly rebleeding and abdominal compartment syndrome. Decision of very early reoperation is most difficult to take.
Létoublon
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Service de Chirurgie Générale et Digestive, Hôpital Michallon, Grenoble. letoublon@ujf-Grenoble.fr
Arvieux
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D001803:Blood Transfusion; D006439:Hemodynamics; D006465:Hemoperitoneum / Q000628:therapy; D006801:Humans; D010535:Laparoscopy / Q000009:adverse effects; D007813:Laparotomy / Q000009:adverse effects; D008099:Liver / Q000293:injuries*; D011312:Pressure; D012086:Reoperation; D015503:Surgical Sponges; D015996:Survival Rate; D014949:Wounds, Nonpenetrating / Q000145:classification / Q000601:surgery / Q000628:therapy*