Abstract
The surgical approach to liver injury depends on a clear and concise characterization of the wound. Blunt trauma can produce devastating wounds that disrupt hepatic venous drainage. Atrial caval shunting remains a useful technique for Grade V liver wounds. Liver packing may be necessary if diffuse lobar injury, acidosis, hypothermia, and coagulapathy are present. The general surgeon must have a wide array of surgical options that can be used for various combinations of injury. This article proposes that operatively identified retrohepatic hematomas, which remain unchanged after a period of observation, should be left undisturbed. Data supporting this approach, from a series of cases managed nonoperatively, are presented.
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Selected References
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- Burch J. M., Feliciano D. V., Mattox K. L. The atriocaval shunt. Facts and fiction. Ann Surg. 1988 May;207(5):555–568. doi: 10.1097/00000658-198805000-00010. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Bynoe R. P., Bell R. M., Miles W. S., Close T. P., Ross M. A., Fine J. G. Complications of nonoperative management of blunt hepatic injuries. J Trauma. 1992 Mar;32(3):308–315. doi: 10.1097/00005373-199203000-00008. [DOI] [PubMed] [Google Scholar]
- Moore E. E. Edgar J. Poth Lecture. Critical decisions in the management of hepatic trauma. Am J Surg. 1984 Dec;148(6):712–716. doi: 10.1016/0002-9610(84)90422-7. [DOI] [PubMed] [Google Scholar]
- Moore E. E., Shackford S. R., Pachter H. L., McAninch J. W., Browner B. D., Champion H. R., Flint L. M., Gennarelli T. A., Malangoni M. A., Ramenofsky M. L. Organ injury scaling: spleen, liver, and kidney. J Trauma. 1989 Dec;29(12):1664–1666. [PubMed] [Google Scholar]
- Moore F. A., Moore E. E., Seagraves A. Nonresectional management of major hepatic trauma. An evolving concept. Am J Surg. 1985 Dec;150(6):725–729. doi: 10.1016/0002-9610(85)90417-9. [DOI] [PubMed] [Google Scholar]
- Pachter H. L., Spencer F. C., Hofstetter S. R., Liang H. G., Coppa G. F. Significant trends in the treatment of hepatic trauma. Experience with 411 injuries. Ann Surg. 1992 May;215(5):492–502. doi: 10.1097/00000658-199205000-00012. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Svoboda J. A., Peter E. T., Dang C. V., Parks S. N., Ellyson J. H. Severe liver trauma in the face of coagulopathy. A case for temporary packing and early reexploration. Am J Surg. 1982 Dec;144(6):717–721. doi: 10.1016/0002-9610(82)90557-8. [DOI] [PubMed] [Google Scholar]
- Walker M. L. Trauma-adult respiratory distress syndrome. J Natl Med Assoc. 1991 Jun;83(6):501–504. [PMC free article] [PubMed] [Google Scholar]