Hepatic trauma

Hepatic trauma is a common form of abdominal injury. Although the majority of hepatic injuries are minor and require little or no treatment, many hepatic injuries are major and lethal if not managed appropriately. Good management of these patients requires a thorough understanding of hepatic anatomy and of the options available for surgical management of hepatic injuries. These options include simple suture, hepatotomy to expose the bleeding vessels and ligation, hepatic artery ligation, packing of hepatic injuries, and, rarely, formal anatomic lobectomy and atriocaval shunting. The trauma surgeon must be familiar with these types of management and be able to apply them in appropriate situations. Nonoperative management is now being reported more commonly and it may be appropriate in a selected group of patients. While the most common cause of death after hepatic injury is from exsanguination occurring early after injury, patients with major hepatic injury remain at risk for a variety of complications after the initial injury. These include hepatic abscess, hemobilia, pseudoaneurysm, and arteriovenous malformations that lead to bleeding. All of these are best treated by CT scan and interventional radiologic techniques. A determined and committed approach to these injured patients can significantly decrease the mortality of these injuries.