• Damage control laparotomy
• Emergent resection
• Hepatic resection
• Traumatic liver injuries

• Adult
• Humans
• Laparotomy/adverse effects
• Treatment Outcome
• Retrospective Studies
• Liver/surgery
• Liver/injuries
• Abdominal Injuries

• Angioembolization
• Liver
• Non-operative management
• Trauma

• Abdominal Injuries/complications
• Compartment Syndromes
• Humans
• Injury Severity Score
• Liver/injuries
• Retrospective Studies
• Wounds, Nonpenetrating/complications

• hepatic
• liver
• trauma

• Angioembolization
• Hemodynamic stability
• High-grade liver trauma
• Non-operative management
• Operative management

• Humans
• Liver/injuries
• Patient Selection
• Wounds, Nonpenetrating/therapy

We aimed to review liver injury experience in a level 1 trauma center; namely clinical presentation, grading, management approach and clinical outcomes.

It is a retrospective analysis to include all blunt liver injury patients who were admitted at the Level 1 trauma center over a 3-year period. Data were compared and analyzed based on the liver injury grades and management approaches.

Blunt liver injury accounted for 38% of the total blunt abdominal trauma cases with a mean age of 31 ± 13 years. Liver injury grade II (44.7%) was most common followed by grade I (28.8%), grade III (19.1%), grade IV (7.0%) and grade V (0.4%). Blood transfusion was more frequently required in patients with grade IV (p = 0.04). Out of 257 patients with blunt liver trauma, 198 were initially treated conservatively, that was successful in 192 (97%), whereas it failed in 6 (3%) patients due to delayed bleeding from hepatic hematoma, associated splenic rupture and small bowel injury which mandate surgical intervention. Fifty-nine patients (23%) underwent emergent surgery in terms of packing, resection debridement, left lobe hepatectomy and splenectomy. Hepatic complications included biloma, pseudoaneurysm and massive liver necrosis. Subanalysis of data using the World Society of Emergency Surgery (WSES) classification revealed 19 patients were categorized as a WSES grade IV who needed surgical intervention without having an initial computerized tomography scanning. The overall mortality was 7.8% which was comparable among the conservative and operative group.

In our center, low grade liver injury in young males prevails. NOM is successful even for high graded injuries. All conservatively treated patients with high-grade liver injuries should be closely monitored for signs of failure of the non-operative management. Introducing the new WSES classification makes clear how is important the hemodynamic status of the patients despite the lesion. However, further larger prospective and multicenter studies are needed to support our findings.

• Blunt hepatic trauma
• Complications
• Liver injury grades
• Management
• Outcome

• Biliary fistula
• CT-scan
• Interventional
• Liver
• Non-operative management
• Radiology
• Therapeutic embolization
• Trauma
• Trauma centers

Interventional radiology (IR) has become an integral part in the management of traumatic injuries. There is an ever-increasing role of IR in traumatic injuries of solid abdominal organs, pelvic and peripheral arteries to control active bleeding by therapeutic embolization or vascular reconstruction using stent grafts. Traditionally, these endovascular treatments have been offered to hemodynamically stable patients. However, in recent times endovascular approach has become preferable to surgery even in hemodynamically unstable patients with injury of surgically difficult-to-access sites. With shifting trends towards non operative management coupled with availability of the current state-of-the-art equipments, hardware and technical expertise, IR has gained an impeccable role in trauma management. However, due to lack of awareness and widespread acceptance, IR continues to remain an ocean of unexplored potentialities.

• Blunt abdominal trauma
• Pelvic trauma
• Peripheral arterial injury
• Interventional radiology
• Embolization

• Blunt trauma
• Hemodynamic instability
• Hypovolemic shock
• Primary survey
• Trauma team
• Triage

• complications
• hepatic trauma
• non-operative therapy
• surgery

The aim of this study was to compare operative versus non-operative management of patients with liver injury and to ascertain the differences of the clinical features.

From April 2000 to July 2012, 191 patients were admitted to Seoul St. Mary's Hospital and St. Vincent's Hospital for liver injuries. Of these, 148 patients were included in this study. All patients were diagnosed using computed tomography (CT). The liver injury was graded in accordance with the American Association for the Surgery of Trauma liver injury scoring scale. Patients were divided into two groups: those who underwent surgery and those treated with non-operative management (NOM). There was a comparison between these two groups concerning the clinical characteristics, grade of liver injury, hemodynamic stability, laboratory findings, and mortality.

According to the 148 patient records evaluated, 108 (72.9%) patients were treated with NOM, and 40 (27.1%) underwent surgery. Patients treated with NOM had significantly fewer severe injuries as rated using the Revised Traumatic Injury Scale, Injury Severity Score, and Glasgow Coma Scale. Grade of liver injury and number of patients with extravasation of contrast dye on CT and hemoperitoneum were higher in the operative group than in the NOM group. There were significant differences between the two groups for: heart rate, respiratory rate, systolic blood pressure, and mean hemoglobin levels at admission and after 4 hours. The operative group experienced a significantly higher mortality than the NOM group.

The results of our study suggest that hemodynamic stability and the following should be considered for deciding the treatment for liver injuries: grade of liver injury, amount of blood loss, and injury scales scores.

• Abdominal injury
• Liver
• Liver injury
• Operation
• Trauma