![]() The severity of penetrating injury depends upon the trajectory of the missile or implements. Most common cause of penetrating liver injury are due to knife assaults and gunshot wound. Not surprisingly, even in the penetrating abdominal trauma, the liver is the second most commonly injured organ. Motor vehicle accident is the most common cause of blunt liver injury. ![]() The support of Glisson’s capsule is easily disrupted making this organ vulnerable to injury. It is highly vascular in nature and has fragile parenchyma. Liver is anterior in the abdominal cavity in right upper quadrant. It is surrounded by many organs and have attachments with peritoneal ligaments, giving it a relatively fixed position. The liver is the biggest solid abdominal organ. Many factors contribute to the vulnerability of liver to injury in trauma. It can extend from minor subcapsular hematomas and small capsular lacerations to major deep parenchymal lacerations, major crush injury, and vascular avulsion. Injury to liver ranges from major and serious to minor non serious injuries. Both these factors have led progressively to the acceptance of nonoperative management (NOM) and a resultant decrease in mortality rates. In addition, there is better imaging of the injured liver by computed tomography (CT). Nowadays, it is recognized that between 50% and 80% of liver injuries stop bleeding spontaneously. If DPL is positive for blood, it was an indication for exploratory celiotomy. Previously, a diagnostic peritoneal lavage (DPL) was done to find out active bleeding and to diagnose missed intra-abdominal injuries needing surgical intervention. The management of hepatic injuries has evolved over the past 30 years. ![]() Since the liver gets frequently injured with other abdominal organs following abdominal trauma, associated injuries contribute significantly to mortality and morbidity and may cause the liver injury to be masked and diagnosis delayed. By trauma, the identification of serious intra-abdominal injuries is a challenging task many injuries may not be apparent during the initial assessment and treatment period. The most common way liver gets injured is in blunt abdominal trauma. In abdominal injuries, liver trauma is the leading cause of death. In close location of many organs, it is difficult to make differential diagnosis between pelvic or intractable abdominal injuries. Almost 13% and 16% of cases have spleen and liver injuries, respectively, and pelvic injuries are seen in about 28% of cases. About 31% patients of polytrauma have abdominal injuries. The liver remains the most frequently and seriously injured abdominal organ due to trauma. As per the estimate of the World Health Organization, by 2020, trauma will be the first or second leading cause of years of productive life lost for the entire world population. Trauma is the second largest cause of hospital admission with 16% of global burden of all health cost. Today despite advancement in recognition, diagnosis, and management, the mortality remains high. The recognition that between 50 and 80 per cent of liver injuries stop bleeding spontaneously, coupled with better imaging of the injured liver by computed tomography (CT) and efficient ICU management, has led progressively to the acceptance of nonoperative management (NOM) with a resultant decrease in mortality rates.Ībdominal trauma is an emergency condition and, if not treated properly, is associated with significant morbidity and mortality. Prior to that time, a diagnostic peritoneal lavage (DPL) positive for blood, was an indication for exploratory celiotomy because of concern about ongoing hemorrhage and/or missed intra-abdominal injuries needing repair. Management of hepatic injuries has evolved over the past 30 years. Liver frequently injured following abdominal trauma and associated injuries contribute significantly to mortality and morbidity, and may mask the liver injury and causes delay in diagnosis. Identification of serious intra-abdominal trauma is often challenging many injuries may not manifest during the initial assessment and treatment period. The most common cause of liver injury is blunt abdominal trauma. ![]() Liver trauma is the most common cause of death after abdominal injury. Abdominal injuries occur in 31% of patients of polytrauma with 13 and 16% spleen and liver injuries respectively, and pelvic injuries in 28% of cases, making differential diagnosis between pelvic or intractable abdominal injury difficult. The liver is the most frequently injured abdominal organ. ![]()
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