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Liver Trauma: Operative and Non-operative Management

Background: The liver is the second most commonly injured organ in abdominal trauma, but liver damage is the most common cause of death after abdominal injury. Although urgent surgery continues to be the standard for hemodynamically compromised patients with hepatic trauma, there has been a paradigm shift in the management of patients who have stable hemodynamic. A marked change toward a more conservative approach in the treatment of abdominal trauma has been noted during the last decades. Modern treatment of liver trauma is increasingly non-operative.

Purpose: To find the epidemiology, etiologies and managements of liver trauma in a population based study in Iran.

Material and Method: A study including 16,287 trauma patients referred to the main hospitals of seven cities with different geographic patterns was done in Iran. Eighty-four patients with hepatic trauma during the 1-year period ending March 2000 included in this Cross-Sectional study. We determined the incidence, etiology and management of the patients suffering liver injury. Analysis was done using SPSS 18. Statistical significance was set at P<0.05.

Results: Out of 16287 trauma patients 84 (0.5%) had hepatic trauma with male predominance 68(81%). The most type of trauma was blunt and the main cause was motor vehicle crashes. Thirty patients (35.7%) managed non-operatively. There was no significant difference in hospital stay between patients operated and managed non-operatively. There was no mortality in the patients managed non-surgically.

Conclusion: In this study hepatic trauma was in 3.7% of abdominal trauma patients. This study concluded non-operative management of hepatic injuries is associated with a low overall morbidity and does not result in increases in length of stay. Non-operative management is a safe approach for the patients of liver trauma with stable hemodynamic.

Author(s): Moosa Zargar, Marjan Laal

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