Trauma in the cirrhotic patient

Cirrhotic patients requiring emergency abdominal surgery exhibit a significant increase in mortality. Unlike the elective surgical patient in whom there is often the opportunity to control ascites, improve nutritional status, and correct coagulation abnormalities, the trauma patient may need to undergo immediate emergency surgery to control bleeding or contamination. The operation may present significant technical difficulties in achieving hemostasis. Indicators of poor outcome at admission include ascites, hyperbilirubinemia, elevated prothrombin time, multiple injuries, and blunt abdominal trauma requiring celiotomy.