BLUNT LIVER TRAUMA - A NEW CONCEPT FOR CLASSIFICATION OF LIVER TRAUMABASED ON VESSEL INJURY

We reviewed a consecutive 143 cases of blunt liver trauma, 43 children and 100 adults, to clarify the pathosis of liver trauma and to reason ably select treatment, non-operative or operative management. The prim ary determinant in the prognosis of liver trauma was clearly hemorrhag e due to vessel injuries and its main treatment method was hemostasis. We developed a new concept for the classification of blunt liver trau ma based on vessel injuries: I = subcapsular Glissonian vessel injurie s, II = transcapsular Glissonian vessel injuries and III = in-/out-flo w vessel injuries and 3 basic types were divided into 2 subtypes, resp ectively. Distribution of liver trauma according to the present classi fication was as follows: type I=23% in child cases and 22% in adult ca ses, type II=65% and 64% and type III=12% and 14%, respectively. The m ain management was non-operative for type I, minor or major surgery fo r type II, and extended surgery for type III. The analysis of dead cas es showed the following: I=0% in child cases and 6% in adult, II=60% a nd 55%; III=40% and 39%, respectively. The first direct cause was hemo rrhage: 60% in child cases and 49% in adult. The present classificatio n was applicable for both child and adult patients, and presented a se lection of management for liver trauma, suggesting the prognosis.