Liver Trauma Management in Traumatological Centre Faculty Hospital Královské Vinohrady Liver Trauma Management in Traumatological Centre Faculty Hospital Královské Vinohrady
Abstract
INTRODUCTION: The liver is the second most frequently injured abdominal organ. In a blunt mechanism the most frequent causes include traffic accidents and falls.
Penetrating injuries of the liver are often a result of a puncture or stabbing. An adequate diagnostic and therapeutic procedure in liver trauma is of great importance, because a complex liver injury in polytraumatized patient is associated with the development of posttraumatic reaction (hypothermia, acidosis, coagulopathy) and its consequences for the diagnostic and therapeutic algorithm.
The beneficial diagnostic element is the examination by multidetector computed tomography (MDCT) to display the extent of the accident lesion with its classification and further indication of treatment. The treatment procedures have advanced to inclusion of non-surgical treatment and "damage control surgery * as well as angioembolization.
Patients with injuries to the liver of grade III are usually treated conservatively. Extensive liver injury of grade IV to V is indicated for surgical revision to even a temporary stop of bleeding in a stage treatment through "damage control surgery".
THE AFFECTED, METHOD AND RESULTS: Based on a retrospective analysis we evaluated the procedure in 42 injured hospitalized with injuries to liver in the traumatology center in 2012-2014. Blunt liver injury was diagnosed in 36 patient, of which 21 within polytrauma.
In four patients, liver injury originated in diagnostic puncture and in two as a result of stab and gunshot. According to the extent of the injury of grade II and III prevailed (17 and 18 wounded).
Non-surgical treatment was indicated in 20 patients and surgical revision in 22 of the injured. Individual interventions on the liver included parenchyma suture in 13 patients, in six of whom complemented with perihepatic packing.
In addition to ligation of the injured larger vascular branch a tamponade was made in four injured with liver injury of grade III and IV. Another two patients with grade IV liver injury were treated by partial debridement of devitalized tissue with non-anatomical resection of torn parenchyma.
Nephrectomy and splenectomy was performed for complex kidney and spleen injury in other two patients. From a total of 22 operated patients the "damage control surgery" was performed in 12 injured.
In posttraumatic period within 30 days we have not observed death related to liver injury. CONCLUSION: The management of liver injury is determined by heterogenicity of anatomical configuration of liver injury, hemodynamic status and associated injuries within polytrauma.
Although the importance of non-surgical treatment, and the number of the injured has been growing, the concept of "damage control surgery" is a method of choice for large hepatic injuries. Perihepatic tamponade has been widely accepted technique to stop bleeding.
The improvement of the results in the treatment of liver injury is determined by multidisciplinary approach with inclusion of damage control resuscitation algorithm and post-operative and post-traumatic intensive care for severe lethal triad.