Liver trauma

Dr Henry Knipe et al.

The liver is one of the most frequently damaged organs in blunt trauma, and liver trauma is associated with a significant mortality rate.

In blunt abdominal trauma, the liver is injured ~5% (range 1-10%) of the time 1,3.

Patients can present with right upper quadrant pain, right shoulder tip pain (from diaphragmatic irritation), hypotension and shock 3.

Aetiology

The mechanism for liver trauma can be from blunt (e.g. motor vehicle collision, fall, direct blow, etc.) or penetrating trauma (e.g. gunshot, stabbing). It can also be iatrogenic (e.g. percutaneous liver biopsy).

Types

Most (~80%) of liver injuries are minor (grades I to III). There is a range of injuries:

  • laceration (most common)
  • haematoma - subcapsular or intraparenchymal
  • active haemorrhage
  • major hepatic vein injury
  • AV fistula
Associations

Approximately 80% of the liver injuries are associated with other abdominal injuries 1,3:

Markers

Elevated liver transaminases (ALT/AST) is 100% specific and ~93% sensitive in predicting liver injuries 4,6.

CT

CT is the investigation of choice for evaluating for liver trauma. It is ~95% sensitive and 99% specific for detecting liver injuries 5.

  • lacerations appear as irregular linear/branching areas of hypoattenuation
  • haematomas appear as a hypodensity between the liver and its capsule (and can be differentiated from intra-peritoneal haematoma as these distort the liver architecture) or can be intraparenchymal
  • acute haematomas/haemorrhage are typically hyperdense (40-60HU) compared to normal liver parenchyma
  • muscular diaphragmatic slips may simulate a peripheral laceration but are smoother, non-branching and of muscle density when compared to a laceration

See main article liver injury grading for more details.

Most (>80%) of liver injuries can be treated non-surgically, and in blunt trauma relies on haemodynamic stability rather than a grade of injury 4-5. There is a significant mortality rate of ~8% (range 4.1-11.7%) associated with liver trauma 1. Complications are reported in ~20% of cases of non-operatively treated liver trauma 7:

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Article information

rID: 26319
Section: Gamuts
Synonyms or Alternate Spellings:
  • Hepatic haematoma
  • Liver laceration
  • Hepatic trauma
  • Traumatic liver injuries
  • Liver haematoma
  • Hepatic laceration
  • Liver injury
  • Hepatic liver injury
  • Traumatic liver injury

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Cases and figures

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    Figure 1: injury grading diagrams
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    Case 1: liver laceration (gross pathology)
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    Liver lacerations...
    Case 2: with grade V renal injury
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    Case 3: grade IV liver laceration
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    Case 4: iatrogenic AF fistula
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    Case 5: laceration on ultrasound
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    Heterogeneous ech...
    Case 6: liver contusion with adrenal trauma
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    Case 7: post gun shot injury
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    Case 8: chronic subcapsular haematoma
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    Case 9
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    Case 10: liver laceration with rib fractures and pneumothorax
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