1. Liver Injuries
Liver - # 2 most commonly injured organ in blunt abdominal trauma
Right Lobe >>> Left Lobe
Posterior segment > anterior segment
Caudate injury is rare, usually in assoc w/ right or left lobe injury
Mortality blunt traumatic hepatic trauma – 8-25% (uncontrolled hemorrhage)

2. Liver Injury Forms Laceration Intrparenchymal hematoma Infarction
Subcapsular hematoma

3. American Association of Trauma Surgery – Hepatic Injury Scale
I – Capsular tear, < 1 cm parenchymal depth
II – Parenchymal tear, 1-3 cm depth
III – Parenchymal disruption, > 3cm depth but involving < 25% of the hepatic lobe
IV – Parenchymal disruption, 25-50% of hepatic lobe
V – Parenchymal disruption - > 50% of hepatic lobe
VI – Hepatic avulsion

4. 22 yr female
Driver of pick up truck rear-ended by another 40mph
Hemodynamically stable – BP 140’s/70’s, HR 80’s
Abdomen – soft, nondistended, tender w/ voluntary guarding
Also with open LE fx
Hct 4334 during hospital course
ALT 599, Alk phos 73, LA 1.7
CT Abd/pelvis done
Grade IV Liver laceration
V-shaped – occupies entire 4a segment
Intact hilum
Subcapsular hematoma
Free fluid in pelvis
No active extravasation
Management – SICU observation, no transfusions, HD stable, 5 days bed rest, on floor, plan to d/c to home

5. CT Abd/pelvis – Grade IV Liver Laceration

6. CT Abd/pelvis – Grade IV Liver Laceration

7. CT Abd/pelvis – Grade IV Liver Laceration

8. CT Abd/pelvis – Grade IV Liver Laceration

9. Management Options
Non-operative management of blunt hepatic and splenic injuries = TOC in HD stable pts, irrespective of injury grade
No evidence for routine imaging of HD stable, clinically improving pt
HD unstable = surgery vs. selective hepatic artery embolization (portal system supplies flow to de-arterialized tissue until collaterals develop)

10. References
Practice Management Guidelines for the Nonoperative Management of Blunt Injury to the Liver and Spleen, 2003 Eastern Association for the Surgery of Trauma
Nonoperative management of blunt hepatic trauma: The exception or the rule?, Journal Trauma 1994.
Jason Zolak
CC IV