Blunt liver injury: from non-operative management to liver transplantation.
Therapeutic options for blunt hepatic trauma include both non-operative and operative management. We have reviewed our experience of the management of blunt hepatic trauma, from non-operative to liver transplantation. A total of 72 patients with blunt hepatic injury observed at the first surgical unit of Padua in a 3-year period (1998-2000) were analysed; we also included a patient who had a liver transplant in 1993 for severe liver trauma. Twenty-nine patients (39.7%) were treated conservatively, with a 93% success rate; 60.3% were treated surgically. Suture hepatorraphy was the most common procedure performed (52.3%). Advantages of non-operative management in our experience were the reduced need for transfusion (1.1U versus 4.3U) with 92% of patients not needing transfusion, and a reduced stay in the intensive care unit; there was no liver-related mortality. The overall morbidity in surgical patients was 30%, with 16% liver-related complications. Twelve surgical patients (27.2%) died, with a liver-related mortality of 18.2%. A large number of patients may present with an associated endo-abdominal injury, even in low-grade liver trauma, requiring rapid laparotomy. In high-grade hepatic trauma, the evolution toward liver failure is an indication for liver transplantation.
Veroux
M
M
Department of Surgery and Transplantation, University Hospital, Via S. Sofia, 78, University of Catania, 95123, Catania, Italy. veroux@mbox.unict.it
Cillo
U
U
Brolese
A
A
Veroux
P
P
Madia
C
C
Fiamingo
P
P
Zanus
G
G
Buffone
A
A
Gringeri
E
E
D'Amico
D F
DF
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000465:Algorithms; D002648:Child; D005260:Female; D006498:Hepatectomy / Q000379:methods; D017052:Hospital Mortality; D006801:Humans; D008099:Liver / Q000293:injuries* / Q000601:surgery; D016031:Liver Transplantation / Q000379:methods; D008297:Male; D008875:Middle Aged; D012086:Reoperation / Q000379:methods; D016896:Treatment Outcome; D014949:Wounds, Nonpenetrating / Q000601:surgery / Q000628:therapy*