Review

. 2020 Mar 30;15(1):24.

doi: 10.1186/s13017-020-00302-7.

Liver trauma: WSES 2020 guidelines

Federico Coccolini¹, Raul Coimbra², Carlos Ordonez³, Yoram Kluger⁴, Felipe Vega⁵, Ernest E Moore⁶, Walt Biffl⁷, Andrew Peitzman⁸, Tal Horer^{9

10}, Fikri M Abu-Zidan¹¹, Massimo Sartelli¹², Gustavo P Fraga¹³, Enrico Cicuttin¹⁴, Luca Ansaloni¹⁵, Michael W Parra¹⁶, Mauricio Millán³, Nicola DeAngelis¹⁷, Kenji Inaba¹⁸, George Velmahos¹⁹, Ron Maier²⁰, Vladimir Khokha²¹, Boris Sakakushev²², Goran Augustin²³, Salomone di Saverio²⁴, Emanuil Pikoulis²⁵, Mircea Chirica²⁶, Viktor Reva²⁷, Ari Leppaniemi²⁸, Vassil Manchev²⁹, Massimo Chiarugi¹⁴, Dimitrios Damaskos³⁰, Dieter Weber³¹, Neil Parry³², Zaza Demetrashvili³³, Ian Civil³⁴, Lena Napolitano³⁵, Davide Corbella³⁶, Fausto Catena³⁷; WSES expert panel

Collaborators, Affiliations

Affiliations

¹ General, Emergency and Trauma Surgery Department, Pisa University Hospital, Via Paradisia 1, 56100, Pisa, Italy. federico.coccolini@gmail.com.
² Riverside University Health System, CECORC Research Center, Loma Linda University, Loma Linda, USA.
³ Division of Trauma and Acute Care Surgery, Fundación Valle del Lili, Cali, Colombia.
⁴ Division of General Surgery, Rambam Health Care Campus Haifa, Haifa, Israel.
⁵ Department of Surgery, Hospital Angeles Lomas, Huixquilucan, Mexico.
⁶ Trauma Surgery, Denver Health, Denver, CO, USA.
⁷ Trauma Surgery Department, Scripps Memorial Hospital La Jolla, San Diego, CA, USA.
⁸ Surgery Department, University of Pittsburgh, Pittsburgh, PA, USA.
⁹ Department of Cardiothoracic and Vascular Surgery, Örebro University Hospital, Örebro University, Örebro, Sweden.
¹⁰ Department of Surgery, Örebro University Hospital, Örebro University, Örebro, Sweden.
¹¹ Department of Surgery, College of Medicine and Health Sciences, UAE University, Al-Ain, United Arab Emirates.
¹² General and Emergency Surgery, Macerata Hospital, Macerata, Italy.
¹³ Trauma/Acute Care Surgery & Surgical Critical Care, University of Campinas, Campinas, Brazil.
¹⁴ General, Emergency and Trauma Surgery Department, Pisa University Hospital, Via Paradisia 1, 56100, Pisa, Italy.
¹⁵ General, Emergency and Trauma Surgery Department, Bufalini Hospital, Cesena, Italy.
¹⁶ Department of Trauma Critical Care, Broward General Level I Trauma Center, Fort Lauderdale, FL, USA.
¹⁷ Unit of Digestive Surgery, HPB Surgery and Liver Transplant, Henri Mondor Hospital, Créteil, France.
¹⁸ General and Trauma Surgery, LAC+USC Medical Center, Los Angeles, CA, USA.
¹⁹ General and Emergency Surgery, Massachusetts General Hospital, Boston, MA, USA.
²⁰ Department of Surgery, Harborview Medical Centre, Seattle, USA.
²¹ General Surgery Department, Mozir City Hospital, Mozir, Belarus.
²² General Surgery Department, Medical University, University Hospital St George, Plovdiv, Bulgaria.
²³ Department of Surgery, Zagreb University Hospital Centre and School of Medicine, University of Zagreb, Zagreb, Croatia.
²⁴ General and Trauma Surgery Addenbrooke's Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK.
²⁵ 3rd Department of Surgery, Attiko Hospital, National & Kapodistrian University of Athens, Athens, Greece.
²⁶ Chirurgie Digestive, CHUGA-CHU Grenoble Alpes, Grenoble, France.
²⁷ General and Emergency Surgery, Sergei Kirov Military Academy, Saint Petersburg, Russia.
²⁸ General Surgery Department, Mehilati Hospital, Helsinki, Finland.
²⁹ General and Trauma Surgery Department, Pietermaritzburg Hospital, Pietermaritzburg, South Africa.
³⁰ General and Emergency Surgery, NHS Lothian, Edinburgh, UK.
³¹ Department of General Surgery, Royal Perth Hospital, Perth, Australia.
³² General and Trauma Surgery Department, London Health Sciences Centre, Victoria Hospital, London, ON, Canada.
³³ General Surgery, Tbilisi State Medical University, Tbilisi, Georgia.
³⁴ Trauma Surgery, Auckland University Hospital, Auckland, New Zealand.
³⁵ Division of Acute Care Surgery, University of Michigan Health System, Ann Arbor, MI, USA.
³⁶ ICU Department, Papa Giovanni XXII Hospital, Bergamo, Italy.
³⁷ Emergency and Trauma Surgery, Maggiore Hospital, Parma, Italy.

PMID: 32228707
PMCID: PMC7106618
DOI: 10.1186/s13017-020-00302-7

Review

Liver trauma: WSES 2020 guidelines

Federico Coccolini et al. World J Emerg Surg. 2020.

. 2020 Mar 30;15(1):24.

doi: 10.1186/s13017-020-00302-7.

Authors

Affiliations

¹ General, Emergency and Trauma Surgery Department, Pisa University Hospital, Via Paradisia 1, 56100, Pisa, Italy. federico.coccolini@gmail.com.
² Riverside University Health System, CECORC Research Center, Loma Linda University, Loma Linda, USA.
³ Division of Trauma and Acute Care Surgery, Fundación Valle del Lili, Cali, Colombia.
⁴ Division of General Surgery, Rambam Health Care Campus Haifa, Haifa, Israel.
⁵ Department of Surgery, Hospital Angeles Lomas, Huixquilucan, Mexico.
⁶ Trauma Surgery, Denver Health, Denver, CO, USA.
⁷ Trauma Surgery Department, Scripps Memorial Hospital La Jolla, San Diego, CA, USA.
⁸ Surgery Department, University of Pittsburgh, Pittsburgh, PA, USA.
⁹ Department of Cardiothoracic and Vascular Surgery, Örebro University Hospital, Örebro University, Örebro, Sweden.
¹⁰ Department of Surgery, Örebro University Hospital, Örebro University, Örebro, Sweden.
¹¹ Department of Surgery, College of Medicine and Health Sciences, UAE University, Al-Ain, United Arab Emirates.
¹² General and Emergency Surgery, Macerata Hospital, Macerata, Italy.
¹³ Trauma/Acute Care Surgery & Surgical Critical Care, University of Campinas, Campinas, Brazil.
¹⁴ General, Emergency and Trauma Surgery Department, Pisa University Hospital, Via Paradisia 1, 56100, Pisa, Italy.
¹⁵ General, Emergency and Trauma Surgery Department, Bufalini Hospital, Cesena, Italy.
¹⁶ Department of Trauma Critical Care, Broward General Level I Trauma Center, Fort Lauderdale, FL, USA.
¹⁷ Unit of Digestive Surgery, HPB Surgery and Liver Transplant, Henri Mondor Hospital, Créteil, France.
¹⁸ General and Trauma Surgery, LAC+USC Medical Center, Los Angeles, CA, USA.
¹⁹ General and Emergency Surgery, Massachusetts General Hospital, Boston, MA, USA.
²⁰ Department of Surgery, Harborview Medical Centre, Seattle, USA.
²¹ General Surgery Department, Mozir City Hospital, Mozir, Belarus.
²² General Surgery Department, Medical University, University Hospital St George, Plovdiv, Bulgaria.
²³ Department of Surgery, Zagreb University Hospital Centre and School of Medicine, University of Zagreb, Zagreb, Croatia.
²⁴ General and Trauma Surgery Addenbrooke's Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK.
²⁵ 3rd Department of Surgery, Attiko Hospital, National & Kapodistrian University of Athens, Athens, Greece.
²⁶ Chirurgie Digestive, CHUGA-CHU Grenoble Alpes, Grenoble, France.
²⁷ General and Emergency Surgery, Sergei Kirov Military Academy, Saint Petersburg, Russia.
²⁸ General Surgery Department, Mehilati Hospital, Helsinki, Finland.
²⁹ General and Trauma Surgery Department, Pietermaritzburg Hospital, Pietermaritzburg, South Africa.
³⁰ General and Emergency Surgery, NHS Lothian, Edinburgh, UK.
³¹ Department of General Surgery, Royal Perth Hospital, Perth, Australia.
³² General and Trauma Surgery Department, London Health Sciences Centre, Victoria Hospital, London, ON, Canada.
³³ General Surgery, Tbilisi State Medical University, Tbilisi, Georgia.
³⁴ Trauma Surgery, Auckland University Hospital, Auckland, New Zealand.
³⁵ Division of Acute Care Surgery, University of Michigan Health System, Ann Arbor, MI, USA.
³⁶ ICU Department, Papa Giovanni XXII Hospital, Bergamo, Italy.
³⁷ Emergency and Trauma Surgery, Maggiore Hospital, Parma, Italy.

PMID: 32228707
PMCID: PMC7106618
DOI: 10.1186/s13017-020-00302-7

Abstract

Liver injuries represent one of the most frequent life-threatening injuries in trauma patients. In determining the optimal management strategy, the anatomic injury, the hemodynamic status, and the associated injuries should be taken into consideration. Liver trauma approach may require non-operative or operative management with the intent to restore the homeostasis and the normal physiology. The management of liver trauma should be multidisciplinary including trauma surgeons, interventional radiologists, and emergency and ICU physicians. The aim of this paper is to present the World Society of Emergency Surgery (WSES) liver trauma management guidelines.

Keywords: Adult; Classification; Guidelines; Hemorrhage; Intensive care; Interventional; Liver trauma; Minor; Moderate; Non-operative management; Operative management; Pediatric; Radiology; Severe; Surgery.

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Conflict of interest statement

The authors declare that they have no competing interests.

Figures

**Fig. 1**
Liver trauma management algorithm (SW: stab wound. Number sign indicates wound exploration near the inferior costal margin should be avoided if not strictly necessary. Asterisk indicates angioembolization should be always considered for adults, only in selected patients and in selected centers for pediatrics)

**Fig. 2**
Hemodynamically unstable liver trauma management algorithm (DCS: damage control surgery, ICU: intensive care unit, REBOA-C: REBOA-cava)

See this image and copyright information in PMC

References

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Liver trauma: WSES 2020 guidelines

Collaborators

Affiliations

Liver trauma: WSES 2020 guidelines

Authors

Collaborators

Affiliations

Abstract

Conflict of interest statement

Figures

References

Publication types

MeSH terms

LinkOut - more resources

Full Text Sources