Management of liver trauma in RIPAS Hospital

ABSTRACT

Introduction: The management of blunt and penetrating liver trauma continues to pose a tremendous challenge to surgeons. This study reviews the pattern of liver trauma and its management, both operative and non-operative, in RIPAS Hospital, the only tertiary referral center in Brunei Darussalam. Material and Methods: A retrospective study of patients admitted with liver trauma, with and without other associated injuries between January 2002 and December 2006 to RIPAS Hospital was undertaken. The patients' case records were retrieved. Details on age, sex, mode of injury, pre-operative imaging, severity of liver injury based on the Liver Injury Scale (LIS, grades I to VI), presence of other associated injuries, overall management, complications and outcome were collected and analysed. Results: Twenty patients (male, n = 12) with a mean age of 36 years old (range 20 to 75) were treated for liver trauma (median LIS grade of III, range I to V) during the study period. Road traffic accidents accounted for 75% of the injuries. Thirteen (65%) had high grade injuries (≥ LIS grade III). Seventeen (85%) patients underwent surgical procedures for liver and other associated injuries. Four patients (20%) had non-operative management with one failure (5%). This patient subsequently required surgery. There were six post-operative deaths (mortality 30%). There were three major morbidities (15%) right hepatic artery aneurysm, a right hepatic duct bile leak and left hemiplegia secondary to cerebrovascular accident. Conclusions: In our local setting, blunt liver trauma is often due to road traffic accidents and is associated with a high mortality rate. A majority was of high grades and required urgent surgical interventions. Non-operative management is an option for those with low grade injuries and who are stable.