Late complications of central liver injuries

Twenty-one patients developed complications of central liver injuries requiring reoperation 1 week to several years after the initial injury. Seven patients were from a series of 320 acute liver injuries treated by us, and 14 were referred to us when their complications became evident. Eleven patients had hepatic abscesses, six had sterile hematomas, and four had hemobilia and its sequelae. Seven patients had asymptomatic vascular disruptions detected with angiography. Two patients developed biliary calculi secondary to hemobilia. Treatment was individualized and ranged from hepatostomy to extended hepatic resection. There were four deaths, three of which were related to the liver injury. Iatrogenic factors were responsible for 62% of these complications. The creation of a central hepatic cavity by superficial suturing or by packing was the most frequent cause, but inadequate resection, failure to provide posterior drainage, and hepatic artery ligation were implicated as well. Late complications of central liver injuries should be infrequent, often are preventable, are not subtle, and respond well to established modes of therapy.