Blunt hepatic trauma

Overview

The liver when injured in blunt abdominal trauma represents one of the most life-threatening injuries in trauma patients due to the highly vascular nature of the liver itself.

The optimal management of blunt hepatic trauma requires consideration of the patients’ haemodynamic status, associated injuries and the anatomical liver injury grade to determine whether patients require operative or non-operative management.

The World Society of Emergency Surgery (WSES) provides guidelines for management of traumatic injuries and can aid in the successful diagnosis and therapeutic interventions in the trauma patient. The WSES classification (Table 1) divides liver injuries into four classes considering the American Association for Surgery of Trauma – Organ Injury Scale (AAST-OIS classification (Table 2) and hemodynamic status (Table 3)(see Printable Resources):

Minor hepatic injuries:

• WSES grade I includes AAST-OIS grade I–II hemodynamically stable lesions.

Moderate hepatic injuries:

• WSES grade II includes AAST-OIS grade III hemodynamically stable lesions.

Severe hepatic injuries:

• WSES grade III includes AAST-OIS grade IV–V hemodynamically stable lesions.
• WSES grade IV includes AAST-OIS grade I–VI hemodynamically unstable lesions.

Description

This resource kit provides healthcare workers with an understanding of the diagnostic and therapeutic methods utilised for the optimal management of blunt hepatic trauma.

Learning objectives

• Understand the diagnostic methods and therapeutic interventions implemented in blunt hepatic trauma.
• Demonstrate knowledge of evidenced-based guidelines used to determine the severity of hepatic injury to support management decisions in hepatic trauma, including both operative and non-operative management.

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Further reading