Liver injury

Background
  • Occurs in 5% of all traumas
    • Most common abdominal injury

Clinical Features

Differential Diagnosis

Abdominal Trauma

Evaluation

ATLS Blunt Abdominal Trauma Algorithm
  • Unstable
    • FAST to search for free fluid (vs. DPL if unavailable)
      • Positive: Exploratory laparotomy
      • Negative: CT scan
  • Stable
    • CT scan
      • Exploratory laparotomy, angiographic embolization, conservative management as indicated

American Association for the Surgery of Trauma Grading System
Grade 4 liver laceration (arrow).
The Liver Injury Scale classification
Grade^HematomaLaceration
I
  • Subcapsular: <10% surface area
  • Capsular tear: <1 cm in depth
II
  • Subcapsular: 10-50% surface area
  • Intraparenchymal: <10 cm diameter
  • Capsular tear: 1-3 cm depth, <10 cm length1–3 cm
III
  • Subcapsular: >50% surface area, or ruptured with active bleeding
  • Intraparenchymal: >10 cm diameter
  • Capsular tear: >3 cm depth
IV
  • Ruptured intraparenchymal with active bleeding
  • Parenchymal disruption involving 25-75% hepatic lobe or involves 1-3 Couinaud segments (within one lobe)
V
  • Ruptured intraparenchymal with active bleeding
  • Parenchymal disruption involving >75% of hepatic lobe or involves >3 Couinaud segments (within one lobe)
  • Juxtahepatic venous injuries (inferior vena cava, major hepatic vein)
VI
  • Hepatic avulsion
^Advance one grade for multiple injuries up to grade III

Management
  • Nonoperative management is successful in >90% of patients who are hemodynamically stable
  • Low-grade injuries (grades I–III) can almost always be managed without surgery
    • Higher-grade injuries commonly fail nonoperative therapy.
  • Consider angiographic embolization if:
    • Large amount of hemoperitoneum
    • Vascular injury (contrast blush) on CT

Disposition
  • Typically admission via OR, IR, or floor/ICU for conservative management

See Also

References
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