II. Causes: Liver Trauma

  1. Penetrating Abdominal Trauma
  2. Direct Blow
    1. Liver subcapsular hematoma
    2. Liver intraparenchymal hematoma
  3. Rapid Deceleration Injury (with shearing forces)
    1. Liver Laceration

III. Symptoms

IV. Imaging

  1. FAST Scan or Focused bedside RUQ Ultrasound
    1. Test Sensitivity: 85% for intraabdominal injury
    2. Test Specificity: 99%
  2. CT Abdomen and Pelvis with IV contrast
    1. Indicated in stable patients
    2. Unstable patients should undergo emergent exploratory laparotomy (see below)

V. Grading: Hepatic Injury Scale

  1. Grade 1
    1. Hematoma: Subscapular Hematoma >10% surface area
    2. Laceration: Capsular Tear parenchymal depth <1 cm
  2. Grade 2
    1. Hematoma: Subcapsular hematoma 10-50% surface area, or Intraparenchymal <10 cm diameter
    2. Laceration: Capsular Tear parenchymal depth 1-3 cm, length <10 cm
  3. Grade 3
    1. Hematoma: Subcapsular hematoma >50% surface area, or ruptured hematoma, intraparenchymal >10 cm
    2. Laceration: Capsular Tear parenchymal depth >3 cm
  4. Grade 4
    1. Laceration: Hepatic lobe parenchymal disruption 25-75% or 1-3 Couinaud segments in single lobe
    2. Vascular: Active bleeding from the liver parenchyma into the peritoneum
  5. Grade 5
    1. Laceration: Hepatic lobe parenchymal disruption >75%
    2. Vascular: Juxtahepatic major venous injury (vena cava, major central hepatic veins)

VI. Labs

  1. Complete Blood Count
  2. Comprehensive Metabolic Panel
  3. ABO Type, Screen and Cross Match
  4. Coagulation Tests as indicated

VII. Management

  1. See ABC Management
  2. See Hemorrhagic Shock
  3. Liver injuries spontaneously stop bleeding in 50-80% of cases
  4. Unstable patients should undergo emergent exploratory laparotomy (see below)
    1. Control Bleeding
    2. Repair or resect damaged liver tissue
  5. Stable patients
    1. Observation
    2. Follow serial RUQ Ultrasound (preferred over serial CT Abdomen)

IX. References

  1. Dreis (2020) Crit Dec Emerg Med 34(7):3-21

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Dutch leverlaceratie
German Lazeration der Leber
Japanese カンレッショウ, 肝裂傷
Czech Lacerace ledvin
Portuguese Laceração do fígado
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