The treatment of 179 blunt trauma-induced liver injuries in a statewide trauma center.

The records of 179 patients who were admitted to a statewide trauma center with liver injuries from blunt abdominal trauma are reviewed. The overall mortality for the 119 men and 60 women was 35 per cent. The simpler forms of injury (classes 1, 2, and 3) were easily treated and yielded good results, whereas treatment for major injuries, involving lobar destruction and vena caval injury (classes 4 and 5), yielded poor results. Hepatic artery ligation was successful in only 7 of 17 cases, hepatic lobectomy was successful in 3 of 16 cases, and intracaval shunting was successful in both in which it was attempted. Anatomic variation, severity of injury from blunt abdominal trauma, and perhaps rapidity of evacuation combine to give poor results in these injury categories. While 26 per cent of all mortality occurred in patients with severe head injuries, hemorrhage was the most frequent cause of death (49%). In 19 of these 30 patients, the hemorrhage was from the liver. Infection played a significant role in the deaths of 27 patients. In eight of these 27 patients, the infections were related directly to the liver injury. The number of associated injuries per patient appeared unrelated to the overall outcome of the injury.