Liver Trauma

Mohamed. Hashim Milhim

4th
year medstudent
An-najah national univ.
 Background
 Largest organ,
 2nd most common injured,
 Blunt trauma most common
 Why the liver…
 Friable parenchyma, thin capsule, fixed position
in relation to spine
 prone to blunt injury .
 Right lobe larger, closer to ribs.
more injury
 In children
compliant ribs,
transmitted force
Mechanisms of injury:-

 simple compression against ribs, spine,

 ligamentous attachment to diaphragm and

the posterior abdominal wall ,shear forces
during deceleration injury.
Mechanisms of injury:-
 High-velocity bullet injuries
– burst injuries with distant contusions and
parenchymal disruption.

– Associations
Mechanisms of injury:-

Low-velocity penetrating injury

 Stab wounds
 percutaneous biopsy
 cholangiography
 biliary drainage,
 (TIPS),
 capsular tears, hematoma, bile leaks, arteriobiliary
fistulas, and hemoperitoneum, arterial aneurysms.
Associations:
 Isolated liver injury occurs in less than
50% of patients.
 Blunt trauma 45% with spleen
 Rib fracture  33% with Liver injury
 Injuries
 Parenchymal damage
 Subcapsular hematoma
 Laceration
 Contusion
 Hepatic vascular disruption
 Bile duct injury
 Injuries
 Mild injuries heal in 3 months.
 Moderate injuries heal in 6 months.
 Sever injuries in 9-15 months.
 Clinically
 Symptoms & signs of injury are
 blood loss,
 peritoneal irritation,
 RUQ tenderness, and guarding.
 delayed abscess .
 Signs of blood loss may dominate the picture.
 Biliary peritonitis.
 Labs & Radiology
 Elevated LFTs
 DPL -- high sensitivity
 CT scan is the diagnostic procedure of
choice.
 US.
 MRI ??
 Angiography
 active bleeding
 Transcatheter embolization
 Embolization & stenting for fistulas.
 CT Scan
 Localization.
 monitor healing.
 Grades 1-6
 Classification
(AAST)
I-Subcapsular hematoma<1cm, superficial
laceration<1cm deep.
II-Parenchymal laceration 1-3cm deep,
subcapsular hematoma1-3 cm thick.
III-Parenchymal laceration> 3cm deep and
subcapsular hematoma> 3cm diameter.
IV-Parenchymal/supcapsular hematoma>
10cm in diameter, lobar destruction,
V- Global destruction or devascularization of
the liver.
VI-Hepatic avulsion
Gallbladder injuries…
 Rare
 Predisposing factors.
 contusions, avulsions, lacerations or
perforations.
 Management
 In the past VS now treatment of blunt liver
injury trauma
 86% , 67%
 CT scan diagnosis and follow up
Management…
 Remember associated injuries
 Resuscitate
 Assessment of injury
Spiral CT
Laparotomy
♦ Treatment
 Management…
 consider Cryoprecipitate, FFP
 Rooftop incision
 Control blood Loss
 Suturing of Lacerations
 Resection
 Packing
 Recurrent parenchymal bleeding
transcatheter embolization
Thank you