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Review
. 2023 Aug;94(8):669-674.
doi: 10.1007/s00104-023-01858-1. Epub 2023 May 4.

[Management and treatment of liver injuries after blunt abdominal trauma]

[Article in German]
M N Thomas  1 , R Whaba  2 , R R Datta  2 , A C Bunck  3 , D L Stippel  2 , C J Bruns  2
Affiliations
Review

[Management and treatment of liver injuries after blunt abdominal trauma]

[Article in German]
M N Thomas et al. Chirurgie (Heidelb). 2023 Aug.

Abstract
in English, German

The liver is involved in about 20% of cases of blunt abdominal trauma. The management of liver trauma has changed significantly in the past three decades towards conservative treatment. Up to 80% of all liver trauma patients can now be successfully treated by nonoperative management. Decisive for this is the adequate screening and assessment of the patient and the injury pattern as well as the provision of the appropriate infrastructure. Hemodynamically unstable patients require immediate exploratory surgery. In hemodynamically stable patients, a contrast-enhanced computed tomography (CT) should be performed. If active bleeding is detected angiographic imaging and embolization should be performed to stop the bleeding. Even after initially successful conservative management of liver trauma, subsequent complications can occur that make surgical inpatient treatment necessary.

Die Leber ist in ca. 20 % der Fälle eines stumpfen Bauchtraumas beteiligt. Das Management des Lebertraumas hat sich in den letzten 3 Jahrzehnten maßgeblich in Richtung konservative Therapie verändert. So können mittlerweile bis zu 80 % aller Lebertraumapatienten durch ein nichtoperatives Management erfolgreich therapiert werden. Entscheidend hierfür ist die adäquate Sichtung und Einschätzung des Patienten und des Verletzungsmusters sowie das Vorhalten der entsprechenden Infrastruktur. Hämodynamisch instabile Patienten bedürfen einer sofortigen operativen Exploration. Bei hämodynamisch stabilen Patienten sollte eine Kontrastmittelcomputertomographie durchgeführt werden. Beim Nachweis einer aktiven Blutung sollte diese durch angiographische Darstellung und Embolisation gestillt werden. Auch nach initial erfolgreichem konservativem Management von Lebertrauma können Folgekomplikationen auftreten, die eine operative Therapie im stationären Verlauf notwendig machen.

Keywords: Active bleeding; Injury pattern; Liver resection; Nonoperative management; Subsequent complications.

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References

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