Blunt liver trauma: an analysis of 75 treated patients

The surgical management of 75 consecutive blunt liver injuries seen at the Albany Medical Center between 1969 and 1973 is reviewed and analyzed. The most common associated injury was right lower rib fractures which were found in one out of three patients. The spleen was the intra-abdominal organ most commonly injured (one out of four patients). The symptoms and signs of blunt liver injury may be misleading, since in one out of five cases there was no clinical evidence of intra-abdominal injury. The findings of fractured ribs on the right side associated with hypotension and a positive peritoneal tap demand immediate abdominal exploration. In patients with large amounts of disrupted hepatic tissue, a wedge resection was preferred over either simple debridement or hepatic lobectomy. A simple technique for limited hepatic resection provided fast, safe control of massive hemorrhage. The overall mortality was 33.3%. In six patients death was ascribed directly to the liver injury. The results of the present study suggest that death from liver injury per se can generally be prevented by prompt adequate surgical control of hemorrhage. When mortality occurs in these patients it is a result of injury to other organ systems.