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World Journal of Surgery

Published in:

01-12-2009

Management of Liver Trauma

Authors: S. A. Badger, R. Barclay, P. Campbell, D. J. Mole, T. Diamond

Published in: World Journal of Surgery | Issue 12/2009

Abstract

Background

Blunt and penetrating liver trauma is common and often presents major diagnostic and management problems.

Methods

A literature review was undertaken to determine the current consensus on investigation and management strategies.

Results

The liver is the most frequently injured organ following abdominal trauma. Immediate assessment with ultrasound has replaced diagnostic peritoneal lavage in the resuscitation room, but computerised tomography remains the gold standard investigation. Nonoperative management is preferred in stable patients but laparotomy is indicated in unstable patients. Damage control techniques such as perihepatic packing, hepatotomy plus direct suture, and resectional debridement are recommended. Major complex surgical procedures such as anatomical resection or atriocaval shunting are now thought to be redundant in the emergency setting. Packing is also recommended for the inexperienced surgeon to allow control and stabilisation prior to transfer to a tertiary centre. Interventional radiological techniques are becoming more widely used, particularly in patients who are being managed nonoperatively or have been stabilised by perihepatic packing.

Conclusions

Management of liver injuries has evolved significantly throughout the last two decades. In the absence of other abdominal injuries, operative management can usually be avoided. Patients with more complex injuries or subsequent complications should be transferred to a specialist centre to optimise final outcome.

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Title: Management of Liver Trauma
Authors: S. A. Badger
R. Barclay
P. Campbell
D. J. Mole
T. Diamond
Publication date: 01-12-2009
Publisher: Springer-Verlag
Published in: World Journal of Surgery / Issue 12/2009
Print ISSN: 0364-2313
Electronic ISSN: 1432-2323
DOI: https://doi.org/10.1007/s00268-009-0215-z

At a glance: The STEP trials

Springer Medicine

Management of Liver Trauma

Abstract

Background

Methods

Results

Conclusions

At a glance: The STEP trials

Springer Medicine

Abstract

Background

Methods

Results

Conclusions

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