[Surgical management of blunt liver trauma]

From 1986 to 1990, 46 patients with blunt liver trauma were hospitalized and operated on in Kuang Tien General Hospital. Included were 33 males and 13 females with a mean age of 31 years (range: 2 to 62). The mean duration of the follow-up was 43 months. We classified the severity of liver injury with the liver injury scale which was published by the Organ Injury Scaling (O. I. S.) Committee of the American Association for the Surgery of Trauma (A. A. S. T.) in 1989. According to the operative findings, the liver injury of the 46 cases were classified as follows: grade I 4 cases, grade II 18 cases, grade III 16 cases, grade IV 2 cases, grade V 4 cases, and grade VI 2 cases. Among the patients, 4 cases were treated with drainage. Four cases underwent simple repair. Twenty-seven cases were treated with repair and drainage. Three cases underwent debridement and selective ligation of bleeding vessels. Four cases underwent partial resection of liver, and 3 cases required repair of the inferior vena cava. One case was packed with gauze for hemostasis. The mortality rate was 15.2%, and the morbidity rate 30.3%. The most frequent postoperative complications related to the hepatic injury in the patients who survived the initial operation were wound infection (8.7%), intra-abdominal abscesses (6.5%), pancreatitis (6.5%), pulmonary infection (4.3%), and small bowel obstruction (4.3%).