Liver and pancreatic traumaBMJ 2001; 322 doi: https://doi.org/10.1136/bmj.322.7289.783 (Published 31 March 2001) Cite this as: BMJ 2001;322:783
- I J Beckingham,
- J E J Krige
The liver is the most commonly injured solid intra-abdominal organ, but injuries to the pancreas are fairly rare. The primary goal in the treatment of severe abdominal injuries is to preserve life, and management is divided into four sequential phases: resuscitation, evaluation, initial management, and definitive treatment.
Liver trauma constitutes a broad spectrum of injuries. The magnitude of the injury, the management requirements, and the complexity of the surgical repair are determined by the extent, anatomical location, and mechanism of injury. Blunt liver trauma is usually due to road traffic accidents, assaults, or falls from heights, and results in deceleration injuries with lacerations of liver tissue from shearing stresses. High velocity projectiles, close range shotgun injuries, and crushing blunt trauma cause fragmentation of the hepatic parenchyma with laceration of vessels and massive intraperitoneal haemorrhage. Penetrating injuries such as stab or gunshot wounds cause bleeding without much devitalisation of the liver parenchyma.
Resuscitation follows standard advanced trauma life support principles: maintenance of a clear airway, urgent fluid resuscitation, ventilatory and circulatory support, and control of bleeding. Effective venous access should be obtained and volume replacement started immediately. The patient's blood is grouped and crossmatched, and blood samples should be sent for urgent analysis of haemoglobin concentration, white cell count, blood gas pressures, and urea, creatinine, and electrolyte concentrations. Patients should also have a nasogastric tube and urinary catheter inserted.
Clinical features of serious liver injury
Decreased urine output
Low central venous pressure
Criteria for non-operative management of liver injuries
Haemodynamically stable after resuscitation
No persistent or increasing abdominal pain or tenderness
No other peritoneal injuries that require laparotomy
< 4 units of blood transfusion required
Haemoperitoneum <500 ml on computed tomography
Simple hepatic parenchymal laceration or intrahepatic haematoma on computed tomography
A liver injury should be suspected in patients with evidence of blunt …