[Traumatic liver injuries: advances in diagnostic and therapeutic methods]

One hundred five patients affected by traumatic rupture of the liver were admitted in the Emergency Surgical Unit at Ospedale "A. Cardarelli" in Napoli over a period of five years. In 40 patients a conservative treatment was applied, monitoring red blood count, and haemoglobin values as well as abdominal ultrasound and CT scans. The remaining 65 patients underwent surgery for liver trauma. Twelve out of 65 patients presented with an hepatic injury alone whereas in 53 liver injury was associated with other lesions, as splenic rupture, kidney hematoma, bone fracture, chest trauma, diaphragmatic or cranial injury. Eleven out of 65 patients underwent postoperative complications such as bile collection (nine) and biliary fistula (two); however, none of these complicated patients died or underwent further surgery. On the basis of their data the Authors conclude that a careful preoperative assessment and the monitoring of haemodynamic pattern are advisable in patients with liver trauma, allowing the choice of a conservative treatment whenever possible. In the patients undergoing surgical treatment, a more conservative approach should be advocated, with a wider use of intraparenchymal haemostasis and packing, both to improve the haemodynamic status and to refer the patient to specialized units.