Hanan Alghamdi

Additional information is available at the end of the chapter

http://dx.doi.org/10.5772/61333

#### **Abstract**

The liver is the most frequently injured abdominal organ. Abdominal injuries occur in 31% of patients of polytrauma with 13 and 16% spleen and liver injuries respectively, and pelvic injuries in 28% of cases, making differential diagnosis between pelvic or intractable abdominal injury difficult.[1] Liver trauma is the most common cause of death after ab‐ dominal injury. The most common cause of liver injury is blunt abdominal trauma. Iden‐ tification of serious intra-abdominal trauma is often challenging; many injuries may not manifest during the initial assessment and treatment period. Liver frequently injured fol‐ lowing abdominal trauma and associated injuries contribute significantly to mortality and morbidity, and may mask the liver injury and causes delay in diagnosis. Manage‐ ment of hepatic injuries has evolved over the past 30 years. Prior to that time, a diagnostic peritoneal lavage (DPL) positive for blood, was an indication for exploratory celiotomy because of concern about ongoing hemorrhage and/or missed intra-abdominal injuries needing repair. The recognition that between 50 and 80 per cent of liver injuries stop bleeding spontaneously, coupled with better imaging of the injured liver by computed to‐ mography (CT) and efficient ICU management, has led progressively to the acceptance of nonoperative management (NOM) with a resultant decrease in mortality rates.

**Keywords:** Blunt liver trauma, penetrating liver trauma, liver trauma grade, liver lacera‐ tion, subcapsular hematoma, bile leak, hemobilia, biloma, parenchymal destruction, FAST, DPL, stab wound, hepatic artery embolization, nonoperative management

#### **1. Introduction**

Abdominal trauma is an emergency condition and, if not treated properly, is associated with significant morbidity and mortality. Today despite advancement in recognition, diagnosis, and management, the mortality remains high. Trauma is the second largest cause of hospital admission with 16% of global burden of all health cost. As per the estimate of the World Health Organization, by 2020, trauma will be the first or second leading cause of *years of productive life lost* for the entire world population [1].

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The liver remains the most frequently and seriously injured abdominal organ due to trauma. About 31% patients of polytrauma have abdominal injuries. Almost 13% and 16% of cases have spleen and liver injuries, respectively, and pelvic injuries are seen in about 28% of cases. In close location of many organs, it is difficult to make differential diagnosis between pelvic or intractable abdominal injuries [2, 3].

In abdominal injuries, liver trauma is the leading cause of death. The most common way liver gets injured is in blunt abdominal trauma. By trauma, the identification of serious intraabdominal injuries is a challenging task; many injuries may not be apparent during the initial assessment and treatment period. Since the liver gets frequently injured with other abdominal organs following abdominal trauma, associated injuries contribute significantly to mortality and morbidity and may cause the liver injury to be masked and diagnosis delayed. The management of hepatic injuries has evolved over the past 30 years. Previously, a diagnostic peritoneal lavage (DPL) was done to find out active bleeding and to diagnose missed intraabdominal injuries needing surgical intervention. If DPL is positive for blood, it was an indication for exploratory celiotomy. Nowadays, it is recognized that between 50% and 80% of liver injuries stop bleeding spontaneously. In addition, there is better imaging of the injured liver by computed tomography (CT). Both these factors have led progressively to the accept‐ ance of nonoperative management (NOM) and a resultant decrease in mortality rates [4, 5].
