Background. Liver trauma has increased strikingly in the last years, mainly in young patients. In spite of the improved diagnostic modalities and therapeutic solutions, mortality is still high. Methods. Twenty-five patients with liver trauma were observed in our unit in the years 1990-1996 and they are retrospectively analyzed. Most of the cases had a blunt trauma while only one patient had a penetrating injury. US and abdominal CT scans were performed only in 17 patients who were hemodynamically stable. The other 8 patients were submitted immediately to surgery being deeply hypotensive, with a systolic blood pressure less than 80 mmHg. Surgery was necessary in 14 patients to control bleeding with suture or debridement and resection of liver segments. Results. In 68% of the cases associated lesions of other organs were present. Conservative therapy was successful in 11 patients. Sensibility of US and CT scan was respectively 88 and 100%. Postoperative morbidity was 21%: in one patient liver transplant was necessary for a severe postoperative liver failure. The overall mortality was 8% (2 patients): in both cases associated lesions were found at surgery. Conclusions. As a conclusion, our experience favours a conservative approach, if the patients is hemodynamically stable, mainly for the reliability of the diagnostic tools allowing an accurate monitoring of the patients. Surgical treatment is reserved to unstable patients and sometimes complexe lesions require multiple clamping of the vessels going to the liver; in cases of uncontrolled bleeding, temporary packing with further resuscitation and subsequent operative treatment within 24-72 hours is recommended.
|Appare nelle tipologie:||1.1 Articolo su rivista|