Treatment of blunt liver injuries after the paradigm shift in liver trauma management

Abstract

Background: The results of contemporary tailored management of blunt liver trauma in a tertiary liver and trauma center are presented. Methods: Retrospective analyses of consecutive patients treated for blunt liver injury between 1.1.2008 and 1.1.2015. Patients with other than blunt injury were excluded. The Organ Injury Scaling (OIS) as documented by the initial emergency spiral-Ct scan was used for the classification of the liver trauma. OIS 1 or 2 values were considered as low grade injuries whereas values from 3-6 were considered as high grade injuries. Results: 49 patients [18 to 86 years] with blunt liver trauma were treated. The mean AIS and ISS value was 6.4 (+/-2.9) and 22.2 (+/-14.7), respectively. 8 / 36 (22.2%) patients with high grade liver injuries underwent emergency laparotomy immediately upon admission and 3 others (8.4%) after initial conservative management. One patient (2.8%) was treated by interventional embolization. 2 / 13 (15.4%) patients with low grade injuries underwent emergency laparotomy and another 2 (15.4%) after failure of initial conservative treatment. 2 patients died due to high grade injuries and two more patients due to other injuries. Conclusion: In the era of conservative treatment of blunt liver injury, expertise in emergency liver surgery is still mandatory for the treatment of severely injured patients. The liver associated mortality of high grade liver injuries is 5.6%.