title: Outcomes following liver trauma in equestrian accidents.
abstract: BACKGROUND
  Equestrian sports are common outdoor activities that may carry a risk of liver injury. Due to the relative infrequency of equestrian accidents the injury patterns and outcomes associated with liver trauma in these patients have not been well characterized.
  
  
  METHODS
  We examined our experience of the management of equestrian liver trauma in our regional hepatopancreaticobiliary unit at a tertiary referral center. The medical records of patients who sustained liver trauma secondary to equestrian activities were analysed for parameters such as demographic data, liver function tests, patterns of injury, radiological findings, the need for intervention and outcomes.
  
  
  RESULTS
  20 patients sustained liver trauma after falling from or being kicked by a horse. The majority of patients were haemodynamically stable on admission. Alanine transaminase (ALT) levels were elevated in all patients and right-sided rib fractures were a frequently associated finding. CT demonstrated laceration of the liver in 12 patients, contusion in 3 and subcapsular haematoma in 2. The right lobe of the liver was most commonly affected. Only two patients required laparotomy and liver resection; the remaining 18 were successfully managed conservatively.
  
  
  CONCLUSIONS
  The risk of liver injury following a horse kick or falling off a horse should not be overlooked. Early CT imaging is advised in these patients, particularly in the presence of high ALT levels and concomitant chest injuries such as rib fractures. Despite significant liver trauma, conservative management in the form of close observation, ideally in a high-dependency setting, is often sufficient. Laparotomy is only rarely warranted and associated with a significantly higher risk of post-operative bile leaks.
authors.affiliation: Department of Hepatopancreaticobiliary Surgery, Addenbrooke's Hospital and Cambridge University, Hills Road, Cambridge CB2 0QQ, UK.
authors.forename: Anita
authors.initials: A
authors.lastname: Balakrishnan
authors.affiliation: Department of Hepatopancreaticobiliary Surgery, Bristol Royal Infirmary, Marlborough Street, Bristol BS2 8HW, UK.
authors.forename: Reyad
authors.initials: R
authors.lastname: Abbadi
authors.affiliation: Department of Hepatopancreaticobiliary Surgery, Addenbrooke's Hospital and Cambridge University, Hills Road, Cambridge CB2 0QQ, UK.
authors.forename: Kathryn
authors.initials: K
authors.lastname: Oakland
authors.affiliation: Hepatobiliary Surgery Unit, Manchester Royal Infirmary, Oxford Road, Manchester M13 9WL, UK.
authors.forename: Saurabh
authors.initials: S
authors.lastname: Jamdar
authors.affiliation: Department of Hepatopancreaticobiliary Surgery, Addenbrooke's Hospital and Cambridge University, Hills Road, Cambridge CB2 0QQ, UK.
authors.forename: Simon Jf
authors.initials: SJ
authors.lastname: Harper
authors.affiliation: Department of Hepatopancreaticobiliary Surgery, Addenbrooke's Hospital and Cambridge University, Hills Road, Cambridge CB2 0QQ, UK.
authors.forename: Neville V
authors.initials: NV
authors.lastname: Jamieson
authors.affiliation: Department of Hepatopancreaticobiliary Surgery, Addenbrooke's Hospital and Cambridge University, Hills Road, Cambridge CB2 0QQ, UK.
authors.forename: Emmanual L
authors.initials: EL
authors.lastname: Huguet
authors.affiliation: Department of Hepatopancreaticobiliary Surgery, Addenbrooke's Hospital and Cambridge University, Hills Road, Cambridge CB2 0QQ, UK.
authors.forename: Asif
authors.initials: A
authors.lastname: Jah
authors.affiliation: Department of Hepatopancreaticobiliary Surgery, Addenbrooke's Hospital and Cambridge University, Hills Road, Cambridge CB2 0QQ, UK.
authors.forename: Raaj K
authors.initials: RK
authors.lastname: Praseedom
keywords: Equine accidents; Liver injury; Liver trauma