Observations regarding surgical treatment in liver trauma

The high mortality rate in hepatic trauma is a concern for the surgeons on duty, who most know the physiopathological problems and the decisions needed in view of both hepatic and extrahepatic injures. The mortality rate from liver trauma has fallen from 60% at the beginning of this century, blunt trauma to the abdomen from accidents, is responsible for 80-90% of all liver injures in Europe. The severity of liver injuries in 268 patients in a prospective study (1978-1998), were treated according to a defined protocol. Non operative management was used in first day, for those who were haemodynamically stable on admission. In unstable patients who proceeded to surgery, under optimal condition the mortality rate was 34.3%. Death in patients with multiple injures should only rarely result from liver trauma. 92 patients with minor injures (grade I-II) were treated by simple suture, with mortality rate of 6%. 116 patients (43%) sustained complex hepatic injures (grade III to V); 64 patients with grade III (23%), 36 with grade IV (13%). 16 Patients (5%) grade V, injury under went finger fracture of hepatic parenchyma alone 36. The mortality rate in this group was 18% (III), 36% (IV). 16 patients with grad V injury were managed with 68% mortality rate. Juxtahepatic veins and retrohepatic V.C.I. injury continue to carry a prohibitive mortality rate (90-100%).