Liver trauma in equestrian accidents. A case report

Abstract

Background: Equestrian sports may carry a risk of liver injury. Horse kick injuries usually occur when rides are dismounted, most frequently when grooming without wearing protective equipment. Equine-associated liver injuries are not well studied due to the relative infrequency of these patients. Some of these patients needs surgery to repair liver injuries but most of them can be management with close observation. Methods: We present a case of hepatic trauma due to equine injury. Results: 21-year-old-female, abdominal pain after being kicked by a horse in the right side of the abdomen. On admission: tachycardia (120 bpm) and hipotension (90/40), diffused abdominal tenderness, haemoglobin level of 12 g/dl with elevation of liver transaminases. CT: laceration grade IV of the right liver (AAST scale). Laparotomy was performed. 2 litres of hemoperitoneum were evacuated and a resection of segment VI was carried. No more abdominal injuries were found. After surgery, haemoglobin levels were 9,2 g/dl after receiving 2 transfusions of concentrated red blood cells. The patient was discharged after 6 days, without complications. Conclusion: Liver injuries in equestrian accidents should be suspected and carefully managed. When haemodynamic instability appears, surgical intervention is mandatory for bleeding control. If there is no instability, conservative management could be taken. Radiological intervention such as embolization is an increasingly viable alternative in the non-operative management in stable patients.