Abstract
In spite of its well-preserved anatomical position, liver is the most frequently damaged intraabdominal organ in a blunt abdominal trauma. Blunt liver trauma can be an important cause of morbidity and mortality. Recently, with the progress in the imaging techniques for solid organ traumas and the intensive care units, treatment choices have changed direction from surgical to nonsurgical treatments in hemodynamically stable patients with a blunt liver trauma. In this paper, we report a case admitted to the General Surgery Intensive Care Unit with high grade (Grade 4) liver trauma due to falling from a high place who was treated conservatively and discuss the case in the light of the current literature.
Keywords:
Liver, blunt trauma, non-operative management
References
1
Coughlin PA, Stringer MD, Lodge JP, Pollard SG, Prasad KR, Toogood GJ. Management of blunt liver trauma in a tertiary referral centre. Br J Surg 2004;91:317-21.
2
Richardson JD, Franklin GA, Lukan KJ, Carrillo EH, Spain DA, Miller FB, et al. Evolution in the management of hepatic trauma: a 25-year perspective. Ann Surg 2000; 32:324–30.
3
Lucas CE, Ledgerwood AM. Changing times and the treatment of liver injury. Am Surg 2000;66:337–41.
4
Malhotra AK, Fabian TC, Croce MA, Gavin TJ, Kudsk KA, Minard G, et al. Blunt hepatic injury: a paradigm shift from operative to nonoperative management in the 1990s. Ann Surg 2000;231:804-13.
5
Fang JF, Chen RJ, Lin BC, Hsu YB, Kao JL, Chen MF. Blunt hepatic injury: minimal intervention is the policy of treatment. J Trauma 2000;49:722-8.
6
Anadol AZ, Topgül K, Güngör B, Bilgin M, Kesim M. Künt karaciğer travmalarına konservatif yaklaşım. Ulus Travma Acil Cerrahi Derg 2007;13:222-6.
7
Croce MA, Fabian TC, Menke PG, Waddle- Smith L, Minard G, Kudsk KA, et al. Nonoperative management of blunt hepatic trauma is the treatment of choice for hemodynamically stable patients. Results of a prospective trial. Ann Surg 1995;221:744-55.
8
Troop B, Fabian T, Alsup B, Kudsk K. Randomized, prospective comparison of open and closed peritoneal lavage for abdominal trauma. Ann Emerg Med 1991;20:1290-2.
9
Farnell MB, Spencer MP, Thompson E, Williams HJ Jr, Mucha P Jr, Ilstrup DM. Nonoperative management of blunt hepatic trauma in adults. Surgery 1988; 104: 748–56.
10
Feliciano DV. Continuing evolution in the approach to severe liver trauma. Ann Surg 1992; 216: 521–3.
11
Losty PD, Okoye BO,Walter DP, Turnock RR, Lloyd DA. Management of blunt liver trauma in children. Br J Surg 1997; 84: 1006–8.
12
Parks RW, Chrysos E, Diamond T. Management of liver trauma. Br J Surg 1999;86: 1121–35.
13
Norrman G, Tingstedt B, Ekelund M, Andersson R. Nonoperative management of blunt liver trauma: feasible and safe also in centres with a low trauma incidence. HPB (Oxford) 2009;11:50-6.
