[Liver traumas].

Abstract

The high mortality rate in hepatic trauma is a concern for the surgeons on duty, who must know the physiopathological problems and the therapeutic solutions in order to make the decisions needed in view of both hepatic and extra-hepatic injuries according to the available means. The early vital risk is produced by 2 facts: injuries to the liver, in which bleeding account for the death in every second case, especially in case of vascular disinsertion in the caval-suprahepatic junction, which fortunately occurs rarely; associated intra- or extra-abdominal injuries, which are unfortunately frequent, cause death in every second case of multiple trauma. On the basis of a series of 135 cases in our department and of a bibliographic study, this article is aimed at defining a strategy for treatment that will be adapted to the lesions, in order to try and improve the prognosis. With hemodynamically stable patients, a surgical watch and wait policy is possible under strict observation. Conservative surgery still has to play a dominant part. Hepatic resection is only rarely indicated, if absolutely necessary. Temporary tight packing for a few days, with early reoperation in a specialist department if required, is a logical approach in initially unfavorable circumstances.