The relatively fixed position of the liver and its large
size makes it more prone for injury in blunt trauma of the abdomen. Liver and
spleen together, account for 75% of injuries in blunt abdominal trauma. Though
liver is the second most commonly injured organ in abdominal trauma; it is the
most common cause of death
following abdominal injury. Compared to splenic injuries, management of
liver trauma still remains a challenge in the best of trauma centres.
In the past, most liver injuries were treated surgically.
However evidence confirms that about 86% of liver injuries have stopped
bleeding by the time surgical exploration is performed and 67% of laparotomies
done for blunt trauma abdomen are non-therapeutic. Imaging techniques
especially Computerised Tomographic (CT) scan has created remarkable impact in
managing liver trauma patients by reducing the number of laparotomies. About
80% of adults and 97% of children are presently managed conservatively worldwide
at high volume trauma centres.
The large size of the liver, the friable parenchyma, its
thin capsule and its relatively fixed position make it prone to blunt injury.
Right lobe is more often involved, owing to its larger size and proximity to
the ribs. Compression against the fixed ribs, spine or posterior abdominal wall
results in predominant damage to segments 6, 7 and 8 of the liver (>85%).
Pressure on right hemithorax may propagate through the diaphragm producing
contusion of dome of right lobe of liver.
Liver’s ligamentous attachments to
diaphragm and posterior abdominal wall act as sites of shearing forces during
deceleration injury. Liver injury can also occur as a result of transmission of
excessively high venous pressure to remote body sites at the time of impact. Weaker
connective tissue framework, relatively large size and incomplete maturation
and more flexible ribs account for higher chance of liver injury in children
compared to adults.
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