Outcome and management of blunt liver injuries in multiple trauma patients |
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Authors: | Emilio Domínguez Fernández Michael Aufmkolk U. Schmidt Konstanze Nimtz Frank Stöblen U. Obertacke Reinhard Lange |
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Affiliation: | Chirurgische Klinik, Universit?tsklinikum Mannheim, Fakult?t für Klinische Medizin der Universit?t Heidelberg, Theodor-Kutzer-Ufer 1-3, D-68167 Mannheim, Germany Tel.: +49-621-3832357 Fax: +49-621-3832166, DE Department of Trauma Surgery, University of Essen, Germany, DE Department of General Surgery, University of Essen, Germany, DE Department of Radiology, University of Essen, Germany, DE
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Abstract: | Background: In Germany, abdominal trauma in multiple- trauma patients can be observed in about 25–35% of all cases. Due to major bleeding complications, the initial treatment of blunt abdominal trauma in multiple-trauma patients has high priority. The aim of this study was to discuss management, treatment and outcome of blunt liver injury in multiple-trauma patients treated in our department. Methods: The clinical records of 1192 multiple-trauma patients [injury severity score (ISS) 3–18] treated at the Surgical Department of the University Clinic of Essen from January 1975 to February 1998 were reviewed. Seventy-five patients with an ISS above 18 operated on due to a blunt liver injury could be included. The mean age was 29.82±1.80 years (60 males and 15 females). The degree of injury in this group was high (ISS 37.12±1.06). Results: Twenty-three of the 75 (30.6%) patients died during their hospital stay. Deceased patients were older (27±2 years versus 37±4 years; P<0.01) and had a higher ISS (ISS=34.5±1 versus 43.2±2; P<0.01). In nine cases, death was strongly related to liver injury. Operational blood loss was higher in the group of multiply injured patients with liver injury and in those patients who did not survive (P<0.05). An increased mortality could be seen in this selected patient group when compared with our large collective of multiply injured patients. The age of the patients, the ISS and operative blood loss were the significant factors that influenced the operative mortality after blunt hepatic injuries in our study. Received: 28 October 1998 Accepted: 22 April 1999 |
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Keywords: | Blunt liver trauma Multiple injury Operative management Outcome |
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