A CLINICAL REVIEW OF HEPATIC TRAUMA

Abstract

Twenty patients with blunt hepatic trauma in a three-year period were reviewed. The mean age was 40.3 years, and there were 16 males and 4 females. The most common cause of these traumas was traffic accidents, in 16 cases. The hepatic injuries were classified into type la for 4 cases; type Ib for 6 cases; type II for 3 cases; type IIIa for 3 cases; and type IIIb for 4 cases. Most patients had multiple trauma. As the hepatic injury became more severe, the ISS value rose higher. Operative treatment was performed on one type II and two type IIIb patients, and the other 17 patients were managed conservatively. The two patients with type IIIb hepatic injury who underwent surgery also had damaged to the inferior vena cave and hepatic veins, and could not be salivaged. No death occurred among type I patients, and hepatic injury was not the direct cause of death in Type II or type HIa patients (each one patient with type II and type IIIa liver trauma died of associated injuries). Two patients with type IIIb died of hepatic bleeding. Type I and II injuries can be managed conservatively, and in even type III cases, operation should be decided on hemodynamic stability. Prognosis of severe cases depends on management of the juxtahepatic venous injuries.