Hepatic trauma in Auckland

A retrospective review of 102 cases of hepatic trauma in the Auckland area between 1979 and 1985 is presented. Particular attention has been focused on those cases where there was massive bleeding, and the prognostic factors that govern outcome have been determined. Mechanism and multiplicity of injury, and the presence of severe hypotension (systolic blood pressure less than .80 mmHg) either at presentation or following induction of anaesthesia were the four most important determinants of prognosis. Blunt trauma caused 82% of these cases, with the mortality in this group being 27%, compared with 6% for penetrating trauma cases. The mortality of those patients who presented with a systolic blood pressure less than 80 mmHg was 44% compared with 13% for those whose blood pressure was above 80 mmHg. Thirteen patients sustained severe bursting or avulsion-type injuries, in eight of whom extensive resection of formal lobectomy was performed with a survival of 88%. The remainder exsanguinated either pre-operatively (two patients) or before definitive hepatic surgery was begun (three patients). All patients with caval or retrohepatic venous injuries exsanguinated either pre- or intra-operatively. It is concluded that the mortality of liver injury from blunt trauma far exceeds that of penetrating trauma, and that severe hypotension at the time of presentation indicates a poor prognosis. A good outcome is possible in those patients who have a significant disruption of the liver architecture of one lobe following resection of devitalized tissue. Caval or retrohepatic venous-type injuries carry a grave prognosis.