Management of blunt liver injury: what is new?

Eur J Trauma Emerg Surg. 2015 Jun;41(3):229-37. doi: 10.1007/s00068-015-0521-0. Epub 2015 Apr 23.

Abstract

Nonoperative management has become the surgical treatment of choice in the hemodynamically stable patient with blunt hepatic trauma. The increased use and success of nonoperative management have been facilitated by the development of increasingly higher resolution computed tomography imaging, improved management of physiology and resuscitation (damage control), and routine availability of interventional procedures such as angiography and embolization, image-guided percutaneous drainage, and endoscopy. On the other hand, recognition of the patient who should proceed to immediate laparotomy is of utmost importance. A systematic and logical approach to the control of hemorrhage is required in the operating room. Thorough knowledge of the anatomy and surgical techniques, such as perihepatic packing, effective Pringle maneuver, hepatic mobilization, infrahepatic and suprahepatic control of the IVC, and stapled hepatectomy, is essential.

Publication types

  • Review

MeSH terms

  • Angiography* / methods
  • Clinical Competence
  • Early Diagnosis
  • Embolization, Therapeutic* / methods
  • Hemorrhage / diagnostic imaging
  • Hemorrhage / prevention & control*
  • Hepatectomy / methods
  • Humans
  • Injury Severity Score
  • Laparotomy* / methods
  • Liver / anatomy & histology
  • Liver / injuries*
  • Liver / pathology
  • Practice Guidelines as Topic
  • Tomography, X-Ray Computed* / methods
  • Wounds, Nonpenetrating / diagnostic imaging
  • Wounds, Nonpenetrating / pathology
  • Wounds, Nonpenetrating / surgery*