Comparison of Isolated and Concomitant Liver Injuries: is Hepatic Trauma Entirely Responsible for the Outcome ?

Abstract

Objective: This study was undertaken to examine both isolated and concomitant liver injuries to clarify the role of liver trauma on outcome.

Patients and methods: This retrospective study was a review of all abdominal trauma patients who presented with liver injuries, with or without concomitant injury at Ege University School of Medicine over a 3-year period. Presentation, injury grade, management, and outcomes were analyzed. Patients with isolated hepatic injury (Group A) were compared with patients who had concomitant hepatic injury (liver and spleen/small bowel) (Group B). Significance was set at 95% confidence intervals.

Results: Of 368 patients, 80 (21%) presented with liver injury. Of these, the aetiology was as follows: 53 (66.2%) blunt injury, 19 (23%) penetrating injury, and 8 (10%) gun shot trauma. There were 38 patients in Group A and 42 in Group B. Of these 42 patients, 19 were diagnosed with serious types of injury; eight thoracic, three open long bone fracture, one intra-cardiac, one intracranial. Six additional patients were observed with injuries to large abdominal vessels. Eleven patients (28.9%) with isolated hepatic injury were managed non-operatively. Mortality, intensive care unit and hospital length of stay, and transfusion requirements were significantly higher in Group B. Only the number of transfused blood units and the grade of liver injury were found to be effective on outcome whereas stepwise regression analysis revealed that injury type (penetrating) and blood transfusion were predictive for mortality.

Conclusion: This study highlighted that although isolated liver injury results in good outcome with non-operative management, concomitant injuries to the liver lead to a higher failure and mortality rate. However, liver injury itself is rarely responsible for death.

Key Words:

• Hepatic trauma
• polytrauma.

Additional information

Notes on contributors

P. Yazici

P. Yazici, M.D. Department of General Surgery Ege Univesity School of Medicine Bornova, Izmir, 35100, Turkey Tel.: [phone] Fax: [phone] E-mail: [email protected]