[Prognosis and therapy of liver injury in patients with multiple injuries]

Between 1.7. 1986 and 31.10. 1989 abdominal trauma was seen in 108 (35.8%) of 300 polytraumatized patients, 44 of these showed rupture of the liver. 23 patients belonged to grade I-III (Moore-classification) and 11 patients to grade IV. Extensive bilobar parenchymal destruction (grade V) was found in 10 patients including 6 patients with retrohepatic vena cava injury. 80% of all patients with liver trauma had intraabdominally associated injuries. In Grade I-II (n = 4) patients were treated conservatively and continuously observed by ultrasound. Injuries graded to III (n = 19) and IV (n = 11) were mostly treated by simple suture or segmental resection. In grade V hemihepatectomy was done in 4 cases, in 2 cases combined by packing and in 1 patient packing only. In 3 patients no adequate therapy was possible. The mortality rate being 36% (n = 16), hemorrhagic complications were the most common cause of death (7 of 16 patients). This was due only to the patients graded to V. In comparison the prognostic factor in grade I-IV ruptures were the associated injuries. In all these cases hemorrhage was stopped by a conservative, organ-retaining therapy. No further hemorrhage occurred. Liver packing was mainly used as additional treatment in cases of coagulopathy after resection. Further indications are extensive bilobar parenchymal destruction without the possibility of primary reconstruction and temporary hemostasis to allow transport to a specialized hospital.