Diagnosis and treatment of liver injury - the experience of the University Trauma Center

Background. The incidence of liver injury is increasing steadily because of serious injuries resulting mainly from traffic accidents. The aim of the study was to evaluate the results of the University Trauma Center, with consideration of the present diagnostic and therapeutic possibilities for liver injuries. Methods: Between January 1st 2000 and April 1st 2006 a total of 132 patients with various degrees of liver injury were admitted to the Trauma Center, University Hospital in Pilsen. 76 injured patients (57.6 %) were treated conservatively, and only 56 (42.4 %) received surgical treatment, with a total of 87 operations performed. Results: 10 patients with polytrauma (7.6 %) died of hemorrhagic shock (group Moore IV-VI). Six injured patients (4.5 %) had a complicated course during their hospitalization. The average period of hospitalization was 17 days (1-69 days). Conclusion: The mortality and morbidity of patients with liver injury are comparable in the group presented here with the results of other large trauma centers. If compared with previous years, there has been a considerable decrease in mortality from this serious injury. At present the basic diagnostic means in liver injury are as follows: "bed-side" ultrasonography, spiral computed tomography, and in more complicated injuries magnetic resonance, angiography, or encloscopic retrograde cholangiography. In terms of therapeutic tactics conservative methods prevail in haemodynamically stable patients, irrespective of the degree of liver injury. The surgical policy applies "damage control surgery", where during the initial surgery life-saving and non-time-demanding procedures are the target (e.g. liver tamponade), correcting hypothermia, haemocoagulation and metabolic acidosis. Only after stabilization of the injured patient other definitive procedures are possible.