Treatment of blunt liver trauma

Management of Blunt hepatic injuries is dramatically modified since early 8 0's. Non operative management is presently used in over 80 % of all cases, irrespective of haemoperitoneum and grade of injury. Close observation of t he patient is requested. Laparotomy or laparoscopy must be decided in any c ase of suspected missed injury. Laparotomy is used for worse hemodynamic st atus. Peroperative mortality is mainly attributed to haemorrhage. Agressive surgery has progressively given place to more conservative techniques. Und erstanding of coagulopathy related to massive transfusions, acidosis and hy pothermia led to enhance efficacy of manual compression of the injured live r and of perihepatic packing and planned reoperation. In survivors this abb reviated laparotomy has pitfalls and complications which must be known, mai nly rebleeding and abdominal compartment syndrome. Derision of very early r eoperation is most difficult to take.