**5. Treatment**

The treatment for liver trauma has been modified over the years, since the beginning of the twentieth century, when aggressive surgical treatment

**57**

*Liver Trauma Management*

**6. Indications**

injuries [19].

tive complications [15].

(7.5%), and biliary leakage [20].

**7. Surgical treatment**

hemoperitoneum.

*DOI: http://dx.doi.org/10.5772/intechopen.92351*

treatment, especially after the Second World War.

predominated, which gradually changed over the decades to more conservative

"Miss nothing and fix everything" has long been the dogma for emergency management of visceral trauma, which imposed obligatory emergency laparotomy for any hemoperitoneum. For blunt hepatic trauma, that attitude has been gradually transformed since the 1970s, moving toward avoidance of emergency laparotomy whenever possible [9–11]. Introduction nonoperative management of blunt liver injury has been proven to be an effective treatment option since the late 1990s, regardless of the

Currently, nonoperative management is undertaken in 60–80% of blunt traumatic liver injuries, and [15, 16] the success rate is 82–100% [8, 15, 17]. The overall mortality and morbidity of those cases is 5–8 and 14–18%, respectively [15–17]. The overall mortality in surgically managed patients is 9–18%, but in high-grade injuries (grades III–V) the mortality is around 40%, and the overall morbidity in operated patients is 30–40% [15, 17]. Coimbra et al. [18] have reported that nonoperative management reduces the overall mortality of grade III and IV blunt liver

This approach has been supported by not only the contribution of contrastenhanced CT [9–11] but the endoscopic and radiological adjunctive interventional procedures as well, which have expanded its scope and helped managing postopera-

A review of the literature about the indications and effectiveness of liver angioembolization in the context of trauma showed that the main indications for this procedure are the presence of contrast blush on CT scan (the most common) and failure in nonoperative management and control of continued bleeding after damage control surgery. The authors included 11 articles related to the topic, with the rate of effectiveness of hepatic angioembolization being 93%, and the main complications highlighted were the presence of liver necrosis (15%), abscess formation

Despite the trend of nonoperative treatment and continued advances in the areas of trauma and critical care, uncontrolled bleeding from major liver injury is still the leading cause of death and continues to frustrate trauma surgeons [12]. Therefore, it is crucial for the surgeon to know when surgery is needed. The two most important criteria for indicating immediate operative treatment to a patient with a hepatic injury are the presence of hemodynamic instability and the existence of peritoneal irritation, regardless of the grade of injury or the volume of

There are several surgical techniques that could be applied depending upon the complexity of the lesion including simple manual compression, Pringle's maneuver (clamping of the hepatoduodenal ligament), hepatorrhaphy, hepatectomy, hepatic artery ligation, and liver resection. Finally, in the direst of circumstances and under specific indications, even a liver transplant can be considered [6]. Regarding the incidence of the surgical techniques employed, hepatorrhaphy is generally the most used procedure in most cases, and the least used are epiplonplasty and left hepatec-

tomy, according to a recently published study, as shown in **Table 2** [6].

degree of injury as long as the patient's condition remains stable [12–14].

predominated, which gradually changed over the decades to more conservative treatment, especially after the Second World War.
