The management of blunt liver injuries

Although the general surgeon who takes emergency call may be confronted wit h a patient who has sustained a blunt liver injury, the decrease in road tr auma and work-place accidents has meant that this will be an infrequent occ urrence. Minimal exposure will, of necessity, extrapolate to difficulty in coping with a catastrophic event which comes unheralded, at an inconvenient time and usually when there is less than ideal support. During the past 15 years, there has been an evolution in the treatment of liver injuries whic h is exemplified by a non-operative approach in selected patients and more conservative procedures in those who require operative intervention. At pre sent, 'damage control' is in vogue; do the least possible to control life-t hreatening injuries and come back another day. This is a cogent and admirab le philosophy, provided that the pendulum does not swing ton far and that a planned course of action is place. This paper reviews the present status o f managing blunt liver injuries, with an emphasis on the general surgeon wh o has little cause to be involved with surgery of the liver.