[Diagnostic and therapeutic assessment of liver trauma]

We have observed an increase in the frequency of hepatic trauma. They are very severe (44% of our group in IV-V stage), right hepatic lobe is the most frequently injured (22 patients), are associated with several lesions and in 20% of patients radical proceedings (parenchymal resection) were needed. A high incidence of associated lesions (24 patients), mainly thoracic and cranio-encephalic, have been observed. Therefore we have to improve the vital support measures, both in the accident place and in their transport, as quick and safe as possible, to hospital. We have at present better diagnostic and management methods to evaluate these patients: abdominal puncture, echography and abdominal CT. The echography in emergencies is the examination of choice in severe abdominal trauma and laparatomy is an urgent procedure in uncertain cases. Most of the hepatic traumatisms were treated by conservative surgical procedures (suture, hemostasis and abdominal drainage in 25 patients), but at times hepatic resection was needed (6 patients). The main aim is this surgery is the hemorrhage control, which determines mortality and prompt reoperation. That happened in two cases. Respiratory problems, infection with sepsis, renal failure, biliary fistulas, upper digestive tract hemorrhages and hemobilia, are complications most frequently observed in our patients. The vital support measures (respiratory, cardiovascular, nutritional, neurologic, etc.) improve the clinical evolution. In our patients the mortality rate was 12%. This rate is very similar to the one reported by other authors.