Liver trauma

Background

  • Occurs in 5% of all traumas
    • Most common abdominal injury

Clinical Features

Differential Diagnosis

Abdominal Trauma

Evaluation

Template:ATLS abdominal trauma diagnosis algorithm

American Association for the Surgery of Trauma Grading System

  • grade I
    • Hematoma: subcapsular, <10% surface area
    • laceration: capsular tear, <1 cm depth
  • grade II
    • hematoma: subcapsular, 10-50% surface area
    • hematoma: intraparenchymal <10 cm diameter
    • laceration: capsular tear, 1-3 cm depth, <10 cm length
  • grade III
    • hematoma: subcapsular, >50% surface area, or ruptured with active bleeding
    • hematoma: intraparenchymal >10 cm diameter
    • laceration: capsular tear, >3 cm depth
  • grade IV
    • hematoma: ruptured intraparenchymal with active bleeding
    • laceration: parenchymal disruption involving 25-75% hepatic lobe or involves 1-3 Couinaud segments (within one lobe)
  • grade V
    • laceration: parenchymal disruption involving >75% of hepatic lobe or involves >3 Couinaud segments (within one lobe)
    • vascular: juxtahepatic venous injuries (inferior vena cava, major hepatic vein)
  • grade VI
    • vascular: hepatic avulsion
Advance one grade for multiple injuries up to grade III

Management

  • Nonoperative management is successful in >90% of patients who are hemodynamically stable
  • Low-grade injuries (grades I–III) can almost always be managed without surgery
    • Higher-grade injuries commonly fail nonoperative therapy.
  • Consider angiographic embolization if:
    • Large amount of hemoperitoneum
    • Vascular injury (contrast blush) on CT

Disposition

  • Typically admission via OR, IR, or floor/ICU for conservative management

See Also

References