[Surgical management of liver rupture]

The management of 178 patients with liver trauma (132 male, 46 female; mean age 34 years (range 3-88) presenting from January 1979 to August 1996 is reviewed. There were 165 cases of blunt trauma and 13 cases of penetrating injury. 110 cases were classified as simple injuries (grade I or II) and 68 cases as complex injuries (grade III to V). The overall mortality was 32% (57 patients). The mortality for true hepatic injury was 15.7%. None of the patients with penetrating injuries died. Mortality was influenced by the type of liver injury and the number of associated injuries. The postoperative complication rate was 55%. The most-frequent postoperative complications related to the hepatic injury were intrahepatic or subcapsular hematoma (12.9%) and postoperative bleeding (9.6%). Intraabdominal abscess formation was seen in 2.8%. Operative therapy for liver injuries depends on the grade of the injury. The majority of liver injuries can be managed by simple techniques, including electrocautery and application of hemostatic agents. In complex injuries hepatotomy, direct vessel ligation, and debridement of necrotic tissue is the method of choice (Pachter's procedure). In non-controlled bleeding, perihepatic picking is a standard method.