The operative and nonoperative management of blunt liver injury

The surgical approach to liver injury depends on a clear and concise characterization of the wound. Blunt trauma can produce devastating wounds that disrupt hepatic venous drainage. Atrial caval shunting remains a useful technique for Grade V liver wounds. Liver packing may be necessary if diffuse lobar injury, acidosis, hypothermia, and coagulapathy are present. The general surgeon must have a wide array of surgical options that can be used for various combinations of injury. This article proposes that operatively identified retrohepatic hematomas, which remain unchanged after a period of observation, should be left undisturbed. Data supporting this approach, from a series of cases managed nonoperatively, are presented.