Abstract
Between June 1, 1976 and June 30, 1989 The Regional Trauma Unit at Sunnybrook Medical Centre in Toronto, Ontario, Canada received 3730 patients. Of these 335 (9%) sustained a liver injury, 95% being due to blunt trauma. Open peritoneal lavage was performed on 80% of liver trauma patients (267/335), 99% being true positive. A laparotomy was performed on 97% of patients (324/335). Major surgical treatment was required in 132 patients (41%) and minor treatment in 192 patients (59%). The remaining 11 patients were treated conservatively (n = 3) or died during resuscitation (n = 8). Morbidity directly related to the liver injury was seen in 29 of 249 surviving patients (11%) although overall morbidity was 27% (67/249). Reoperation was required in 6% (14/249) with abscess or hematoma accounting for 11 of 14 operations. The overall mortality rate was 26% (86/335). Eighty two percent of patients (n = 276) had a grade I, II or III liver trauma according to Moore’s classification with a mortality of 12% (n = 32). The remaining 18% of patients (n = 59) had a grade IV or V liver trauma with a mortality of 44% (n = 26). Of the 86 deaths, head injury accounted for 48 (56% of deaths); liver hemorrhage for 17 (20%), liver sepsis for (1%) and other causes for 20 deaths (23%). Thus death due to the liver injury itself (hemorrhage and sepsis) occurred in 18 out of 335 patients (5% overall). Head injury accounted for the death of 48 out of 335 patients (14% overall). Over the past 13 years a trend has occurred at our institution whereby we are seeing less liver trauma in our population of multiply injured patients from 12% (1976–1983) down to 7% (1985–1989); with a gradual decline in overall mortality from 32% (1976–1983) to 19% (1985–1989), whereas the precentage of deaths due to head injuries and liver injury have increased.
Highlights
Liver injury constitutes a major problem in patients suffering from abdominal trauma
The purpose of this paper was to review the outcome of liver injuries at Sunnybrook Medical Centre (SMC) which serves as a Regional Trauma Unit (RTU) for a large area in southern Ontario, Canada over the past 13 years since the inception of the RTU and to study the epidemiology and changes in morbidity and mortality over this time period
Eighty per cent of our liver trauma patients underwent a minilap before laparotomy
Summary
Liver injury constitutes a major problem in patients suffering from abdominal trauma. The liver is the second most commonly injured organ following blunt abdominal trauma[1]. The most common cause in Canada is blunt injury from motor vehicle accidents where the patients are usually multiply injured[2]. The hemodynamic effect of a major liver injury is profound and taxes the reserves of personnel and blood banks in institutions ranging in size from small hospitals to large regional trauma units. Minor liver injuries can be handled, major injuries continue to cause mortality.
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