[Liver injuries]

We report on a series of 193 patients with traumatic liver injuries treated at our Trauma Centre I during the period 1983-94; i.e. about 13 patients per year. The centre has a catchment population of 850,000. Most of the patients were severely injured, with 3.2 injured organs per patient among the 151 patients with multiple injuries. The clinical diagnostic work was supplemented with peritoneal lavage, ultrasonography and computer tomography. 38 patients were not operated on, of whom 25 survived. Exploratory laparotomy with or without liver suturing was used in 125 patients and liver resection in 18 seriously injured patients, with more than 50% mortality. Perihepatic packing was used in 12 patients, all with other serious injuries and with a high rate of mortality from these injuries. Liver injuries can be divided into two groups. A few injured patients are admitted in severe shock, and may be treated with immediate thoracotomy and clamping of the aorta, followed by urgent laparotomy to control bleeding by means of packing. The rest of the abdomen is examined quickly and closed, to avoid well known complications of bleeding and multitransfusions, i.e. hypoxaemia, acidosis and hypothermia. Repeat laparotomy follows in 2-3 days, to remove the packing. A stable patient should be referred for computer tomography, and may be treated without operation, but must be followed closely clinically.