doiSerbia

Severe blunt hepatic trauma in polytrauma patient: Management and outcome

Doklestić Krstina (School of Medicine, Belgrade + Clinical Center of Serbia, Clinic for Emergency Surgery, Belgrade)
Đukić Vladimir (School of Medicine, Belgrade + Clinical Center of Serbia, Clinic for Emergency Surgery, Belgrade)
Ivančević Nenad (School of Medicine, Belgrade + Clinical Center of Serbia, Clinic for Emergency Surgery, Belgrade)
Gregorić Pavle (School of Medicine, Belgrade + Clinical Center of Serbia, Clinic for Emergency Surgery, Belgrade)
Lončar Zlatibor (School of Medicine, Belgrade + Clinical Center of Serbia, Clinic for Emergency Surgery, Belgrade)
Stefanović Branislava (School of Medicine, Belgrade + Clinical Center of Serbia, Department for Anesthesiology, Belgrade)
Jovanović Dušan (Clinical Center of Serbia, Clinic for Emergency Surgery, Belgrade)
Karamarković Aleksandar (School of Medicine, Belgrade + Clinical Center of Serbia, Clinic for Emergency Surgery, Belgrade)

Introduction. Despite the fact that treatment of liver injuries has dramatically evolved, severe liver traumas in polytraumatic patients still have a significant morbidity and mortality. Objective. The purpose of this study was to determine the options for surgical management of severe liver trauma as well as the outcome. Methods. In this retrospective study 70 polytraumatic patients with severe (American Association for the Surgery of Trauma [AAST] grade III-V) blunt liver injuries were operated on at the Clinic for Emergency Surgery. Results. Mean age of patients was 48.26±16.80 years; 82.8% of patients were male. Road traffic accident was the leading cause of trauma, seen in 63 patients (90.0%). Primary repair was performed in 36 patients (51.4%), while damage control with perihepatic packing was done in 34 (48.6%). Complications related to the liver occurred in 14 patients (20.0%). Liver related mortality was 17.1%. Non-survivors had a significantly higher AAST grade (p=0.0001), higher aspartate aminotransferase level (p=0.01), lower hemoglobin level (p=0.0001), associated brain injury (p=0.0001), perioperative complications (p=0.001) and higher transfusion score (p=0.0001). The most common cause of mortality in the “early period” was uncontrolled bleeding, in the “late period” mortality was caused by sepsis and acute respiratory distress syndrome. Conclusion. Patients with high-grade liver trauma who present with hemorrhagic shock and associated severe injury should be managed operatively. Mortality from liver trauma is high for patients with higher AAST grade of injury, associated brain injury and massive transfusion score.

Keywords: blunt liver injury, damage control surgery, American Association for Surgery of Trauma, focused assessment with sonography for trauma, computed tomography, intensive care unit