Management of liver trauma

Background and methods: Management of blunt or penetrating injuries to the liver remains a significant challenge. This review discusses the mechanisms of liver injury, grading system for severity, available diagnostic modalit ies and current management options. It is based on a Medline literature sea rch and the authors' clinical experience. Results: Unstable patients require immediate laparotomy, but selected patie nts who are haemodynamically stable may be managed without operation. The p referred operative techniques include resectional debridement, hepatotomy w ith direct suture ligation and perihepatic packing; anatomical resection, h epatic artery ligation and various bypass techniques have a limited, more d efined role for selected injuries. Major complications include haemorrhage, sepsis and bile leak. Conclusion: Enhanced resuscitation, anaesthesia and intensive care have con tributed to a significant reduction in mortality rates from liver trauma. O ptimum results are obtained with a specialist team that includes an experie nced liver surgeon, anaesthetist, endoscopist and interventional hepatobili ary radiologist with expertise in managing postoperative complications.