Blunt Liver Trauma: Spectrum of injuries and outcomes, managed At Level – I Trauma Center

Abstract

Abstract Introduction: The liver and spleen sustain the greatest intra-abdominal injuries, followed by the intestine and mesentery in blunt abdominal trauma. Overlooked intra-abdominal injuries and surgical management delays are linked to a significant risk of morbidity. Accurate diagnostic investigations, including eFAST and MSCT, are of the highest significance. Patients who are hemodynamically stable (HDS) can often be managed without surgery due to advances in imaging technology, the expansion of minimally invasive techniques, and improved monitoring adjuncts. This study aims to look into the incidence, clinical manifestations, treatment, and consequences of traumatic blunt liver injuries in level – I trauma center in Pakistan. Materials & Methods: This retrospective cohort analysis included all blunt abdominal trauma patients with liver injuries who were admitted and treated at the Lahore general hospital, Lahore, between January 2020 and January 2022. Data collected included demographic characteristics, mode of injury, vital signs, CT findings when accessible, the intensity of the liver trauma, management approach, and outcomes such as duration of hospital admission & mortality. Patients who remained hemodynamically stable were managed conservatively. Results: A total of 124 patients presented with blunt abdominal trauma in the emergency department, out of which 39 reported liver injury. Among them, 33 were male, and the mean age was 31.56 ± 11.04 years. The most frequent mode of injury was motor vehicle collision in 34 patients. Conservative management was done in 16 patients and failed in 3 patients who eventually required operative management. Operative management was done on 23 patients. Most frequently performed procedure was peri-hepatic packing 20 (76.9%). The mortality rate was 3 (7.7%), and all were grade V liver injury patients. Discussion: Liver trauma is among the most common injury after blunt abdominal trauma, constituting a life threat and a reason for emergency department admission. The treatment of liver injuries is multidisciplinary. Patients with severe hepatic trauma whose successful recovery is complicated by hemodynamic instability must undergo surgery. Conclusion: To prevent and minimize the significant consequences, emergency physicians must rapidly assess the severity of the injury and select the most suitable treatment option (surgical or non-surgical).