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Liver trauma

Key sources
The following summarized guidelines for the evaluation and management of liver trauma are prepared by our editorial team based on guidelines from the World Society of Emergency Surgery (WSES 2020), the Society of Interventional Radiology (SIR 2020), the European Federation of Societies for Ultrasound (EFSU 2020), the World Society of Emergency Surgery (WSES/AAST 2019), and the Eastern Association for the Surgery of Trauma (EAST 2012).
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Guidelines

1.Diagnostic investigations

Ultrasound: obtain eFAST for rapid detection of intra-abdominal free fluid.
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  • CT

  • MRCP

  • Hepatobiliary scintigraphy

2.Diagnostic procedures

Endoscopic retrograde cholangiopancreatography: consider performing ERCP in hemodynamically stable or stabilized adult and pediatric patients with suspected extrahepatic biliary tree injury.
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3.Medical management

Setting of care: consider admitting patients with isolated liver injury with moderate (WSES II/AAST III) or severe (WSES III/AAST IV-V) lesions to an ICU.
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  • Nonoperative management

  • Thromboprophylaxis

4.Nonpharmacologic interventions

Enteral feeding: initiate enteral feeding as soon as possible in the absence of contraindications in patients with liver injury.
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  • Early mobilization

5.Therapeutic procedures

Angiography with embolization: as per SIR 2020 guidelines, consider performing embolization in patients with blunt hepatic injury with ongoing bleeding, identification of an arterial source of bleeding on imaging, or suspicion of a persistent source of arterial bleeding despite operative intervention.
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  • REBOA

  • Other interventions for complications

6.Surgical interventions

Indications for surgery: as per WSES 2020 guidelines, perform surgery in hemodynamically unstable and non-responding patients (WSES IV) with liver injury.
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7.Specific circumstances

Pediatric patients: obtain follow-up contrast-enhanced ultrasound for the assessment of complications and reducing ionizing radiation exposure in pediatric patients with traumatic liver injuries.
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