Trends in the management of blunt liver trauma

OBJECTIVE: Blunt liver trauma management has changed over the last 2 decades to include non-operative management as one of the standard approaches, particularly to those with minor liver injury. We reviewed the experience at a non-trauma hospital to identify trends in methods of evaluation and management of blunt liver trauma and discuss its outcome.

METHODS: Medical records of 21 patients who sustained blunt liver trauma between June 1992 and July 1999 were retrospectively reviewed at King Fahad Military Medical Complex, Dhahran, Kingdom of Saudi Arabia.

RESULTS: Thirty-three percent received non-operative management and recovered without complications. The rest received an operative management but in comparison had more severe liver injury scales, higher incidence of associated injuries, significantly greater blood transfusion requirements, longer hospital stay and a mortality rate of 67%.

CONCLUSION: Non-operative management of blunt liver trauma is a valid effective option. It requires less blood transfusion and shorter hospital stay and is associated with a low complication rate. Severe liver injury can be associated with high mortality. Outcome can be significantly affected by both the severity of liver trauma and associated injuries particularly severe head injury. Management of the severely injured is expected to have a better outcome in a trauma centre.