Blunt hepatic injury.

Fifty-six cases with blunt hepatic injuries occurred in 255 laparotomies on patients with multiple injuries. Pre-operatively, one-half of the patients were in profound shock. In these cases hepatic bleeding was often accompanied by bleeding in other sites, usually from a ruptured spleen or into a retroperitoneal haematoma. Diagnosis was aided by laparocentesis and peritoneal lavage. In 3 cases the diagnosis was delayed for 8--12 hours. The lacerations were sutured in 43 cases, a local resection was made in 10 cases and a lobar resection in 3 cases. Manual compression of the liver was the best way of achieving temporary haemostasis. In cases where haemodynamic stability was not achieved post-operatively, immediate re-operation to attain haemostasis was definitely advantageous. The mortality from multiple blunt injuries was high (17%) but especially so in cases with hepatic injury (41%). Liver injuries after blunt trauma can often be managed by suturing, and hepatic resection in seldom necessary.