Traumatic Liver Injury

Kim, Young Jin; Kim, Byung Chun; Lee, Hae Wan; Ryu, Byoung Yoon; Choi, Won Jin; Kim, Hong Ki; Suk, Hong

Abstract

One hundres and two cases of traumatic liver injury were treated during 11 years from January 1986 to December 1996 at the department of surgery, Chunchon Sacred-Heart Hospital, Hallym University, and analysis of clinical manifestation and factors affecting to the mortality were carried out, and the results were as follows. The male to female ratio was 2.6:1. The liver is most commonly injuried following blunt trauma, and the most common cause of blunt trauma was automobile accidents(83.3%). Right lobe injuries consisted of 82.4% of the cases, left lobe injuries were 11.8%, and injuries affecting both lobes were 5.9%. Among the clinical symptoms, peritoneal irritation sign was most common(52.9%). Other symptoms consisted of adominal distension(46.1%), chest pain or dyspnea(42.2%), abdominal wound(12.8%). Arriving at emergency room, patients with shock symptoms were present in 10.8% of all cases. Needle abdominal, paracentesis was performed in 44 cases, and a positive tap showed in 33 cases. In 44.1% of the cases, the liver injury was accompanied with rib fracture, 36.3% with hemothorax or pneumothorax, 32.4% with fracture of long-bone, 17.7% with head injury. Accompaning injuried intraabdominal organs that occured in order from highest to lowest percentage were the kidneys, spleen, small intestines, large intestines, stomach, diaphragm, pancreas and duodenum. Using the AAST Organ Injury Severity Classification, Grade II injuries were 31.4%, Grade I injuires were 28.4%, and Grade III injuries were 19.6%. Conservative management was the preferred method in 26 cases, and operations were performed in 76 cases. Suture and drainage were performed in 66 cases. Hepatic resection procedures were perfromed in three cases. The incidence of complication was 44.1%. The most common post-operative complications were respiratory problems, such as atelectasis, pneumonia, pleural effusion, and ARDS. The mortality rate was 15.7%, and the most common cause of death was hypovolemic shock due to massive bleeding. Accompanying head injuries, renal failue, and ARDS were also cause of death. Factors affecting to the mortality were the severity of the injury, the prescence of shock, systolic blood pressure at arrival, initial value of hematocrit, and the prescence of the abdominal distension.