Management of traumatic liver injuries.

Liver injuries in Europe are usually caused by blunt trauma and a high mortality rate is generally reported. The severity of liver injury in 175 patients was graded from I to V and the Injury Severity Score assessed. Seventy-five patients in a prospective study (1987-1990) were treated according to a defined protocol. Non-operative management was used for those who were haemodynamically stable on admission. In unstable patients who proceeded to surgery, liberal use of packing was made and a low threshold for relaparotomy employed. Increasing experience resulted in fewer indications for resection and a 40 per cent rate of non-operative treatment in the prospectively managed group. The overall mortality rate was 12 per cent (15 per cent in the retrospective and 8 per cent in the prospective group). Death in patients with multiple injuries should only rarely result from liver trauma.