Hepatic trauma. A review of 56 consecutively treated patients

The records of 56 consecutively treated patients with hepatic trauma were reviewed for clinical features, treatment, and results. Nonpenetrating trauma was the cause of 60% of the injuries, 40% of which were considered major. Peritoneal irritability, hypotension, and a positive abdominal paracentesis were common findings leading to abdominal exploration. Prompt fluid resuscitation followed by operation was successful in most patients. Various suture techniques were effectively used to control hemorrhage, and extensive debridement short of lobectomy was used if possible. Drainage was effective in reducing postoperative complications. Death was associated with extensive injuries that required right hepatic lobectomy in two patients, and in three patients deaths were unrelated to the hepatic injury. Complications were predominantly pulmonary problems, sepsis, and hemorrhage. These results support the prompt operative management of hepatic injuries with accepted procedures of debridement, precise vascular and biliary control, and drainage, conserving hepatic tissues.