Immediate and follow-up management of hepatic trauma

There has been a considerable evolution in the management of patients with hepatic injuries in the past 5-10 years. CT is now the mainstay of diagnosis for stable patients with blunt hepatic injuries. This allows for nonoperative therapy in many patients with lacerations, intrahepatic hematomas, or subcapsular hematomas. Simple operative techniques are used in 60% of patients with blunt injuries, and any deaths in this group are usually due to associated injuries. In patients requiring advanced techniques of repair, postoperative management emphasizes basic techniques including correction of hypothermia and coagulopathies and early use of enteral feeding. Postoperative complications are not rare when Class III, IV, or V hepatic injuries have been treated, but can be managed with the assistance of the interventional radiologist, blood bank, or by use of early reoperation. Mortality depends on mechanism of injury and magnitude of hepatic injury, and ranges from 14-31% for patients with blunt trauma.