[Modern imaging techniques for liver trauma]

Role of elevated liver transaminase levels in the diagnosis of liver injury after blunt abdominal trauma

The liver is the second most commonly injured organ following blunt abdominal trauma. The stable patient with minimal physical findings with a history of blunt abdominal trauma presents a challenge for diagnosis of liver injury. This study was conducted to determine the usefulness of hepatic transaminases in predicting the presence of liver injury and its severity following blunt abdominal trauma. In this retrospective study, we included all patients who had sustained blunt abdominal injury and were treated at our institution between January 2008 and December 2010. The grading of the liver injury was verified using CT scans or surgical findings. One hundred and eighty-two patients with blunt abdominal trauma underwent the required blood tests and were included in the study. Using receiver operating characteristic (ROC) curve assessment, optimum alanine aminotransferase (ALT), aspartate aminotransferase (AST), lactate dehydrogenase (LDH) and γ-glutamyl transpeptidase (GGT) thresholds were determined to be >57 U/l, 113 U/l, 595 U/l and 50 U/l. ALT >57 U/l (OR, 66.1; P<0.001) and AST >113 U/l (OR, 30.6; P<0.001) were strongly associated with the presence of liver injuries. This association was also observed in patients with elevated LDH >595 U/l (OR, 3.8; P<0.001) and GGT >50 U/l (OR, 3.0; P<0.05). None of the laboratory tests were related to the severity of the liver injuries. In patients with blunt abdominal trauma, abnormal hepatic transaminase levels are associated with liver injuries. Patients with ALT >57 U/l and AST >113 U/l are strongly associated with liver injury and require further imaging studies and close management.

[Surgical treatment of liver trauma: resection--when and how?]

Liver resection as an emergency procedure in patients with liver injury due to abdominal trauma has become a rare procedure. In most cases liver trauma can be managed conservatively. Currently surgery is only indicated in hemodynamically instable patients and in cases of progredient haematoma where the main aim is control of bleeding. Anatomical liver resection should be avoided and may only be performed in cases of total vascular avulsion. Debridement of devascularized tissue can also be carried out in terms of an atypical liver resection. This article elucidates the current indications for liver resection after traumatic liver injury.