[Differentiated management of hepatic, biliary and pancreatic injuries]

Severe trauma is a frequent cause of death worldwide, especially among younger patients and predominantly due to blunt abdominal trauma. While the liver is often affected, pancreatic injuries are rare. The initial diagnostics include the medical history, physical examination, laboratory tests and the focused assessment with sonography for trauma (FAST). The estimation of hemodynamic stability is decisive. Emergency laparotomy is indicated for critically ill patients and those with an accumulation of free intraabdominal fluid detected by sonography. Stable or stabilizable patients should undergo triphasic contrast-enhanced computed tomography. This enables classification of the injury pattern according to the injury scoring scale of the American Association for the Surgery of Trauma (AAST) and explicit detection of active bleeding and helps to estimate the extent of the injuries. Nonoperative management (NOM) has become established as the standard treatment. In addition to pure monitoring, special interventions are also used. A surgical approach is necessary in cases of instability, extensive injuries or failure of the NOM. The surgical approach depends on the pattern of injury and is similar to that of elective surgery. In addition to local hemostasis resections are possible. Both NOM and complex surgical treatment should be performed at specialized centers.