Blunt Liver Trauma: a Systematic Review

INTRODUCTION. The high incidence of closed liver injuries, general and postoperative mortality dictate the need to find optimal treatment options for those patients.

AIM OF STUDY. To conduct a systematic review of the literature on the comparative evaluation of various treatment options for patients with blunt liver injury.

MATERIAL AND METHODS. A systematic search for non–randomized studies was conducted from 01 October 2015, and randomized studies - without time limits, until December 31, 2023.

RESULTS. There is a clear trend towards non-operative management of hemodynamically stable or stabilized patients, and in case of hemodynamic instability, the use of liver tamponade with angioembolization at the second stage.

CONCLUSION. A larger number of well-planned randomized clinical trials are required to concretize the surgical approach to patients with liver injury.

1. Vladimirova ES, Valetova VV. Temporary hemostasis at severe hepatic injury and its influence on vital functions. Medical Alphabet. 2016; 3(20):14–19. (In Russ.)

2. Ibadildin AS, Kravtsov VI, Ibadildina SA, Iskakova TA. Modern principles of diagnosis and treatment of patients with severe injuries of liver. Bulletin of the Kazakh National Medical University. 2021;3:187–190. (In Russ.)

3. Manukovsky VA, Gavrishchuk YaV, Tulupov AN, Demko AE, Savello VE, Kandyba DV, et al. Possibilities of conservative and minimally invasive treatment of blunt injury to parenchymal abdominal organs in adults. Polytrauma. 2022;3:21–33. (In Russ.). https://doi.org/10.24412/1819-1495-2022-3-21-33

4. Panteleev VS, Nartailakov MA, Salimgareev IZ, Loginov MO, Samohodov SYu, Petrov AS. Surgical treatment of traumatic liver injury with development of biloma, destructive cholecystitis and pseudoaneurysm: a clinical case. Creative surgery and oncology. 2023;13(2):171–177. (In Russ.). https://doi.org/10.24060/2076-3093-2023-13-2-171-177

5. Evtikhov AV, Lyubivyy ED, Kim VL. Treatment of severe liver trauma. Pirogov Russian Journal of Surgery = Khirurgiya. Zurnal im. N.I. Pirogova. 2020;7:89–92. (In Russ.). https://doi.org/10.17116/hirurgia202007189

6. Grintsov AG, Antonyuk SM, Akhrameev VB, Lutsenko YuG, Matiytsiv AB. The question of the treatment of closed injuries of the liver. Bulletin of Emergency and Reconstructive Surgery. 2021;6(1):61–67. (In Russ.)

7. Gavrishchuk YaV, Manukovsky VA, Kolchanov EA, Tulupov AN, Demko AE, Kazhanov IV. Optimization of diagnostics and management of patients with blunt solid organs injuries in a level I trauma center. Kremlin medicine. Clinical Bulletin. 2023;3:28–33. (In Russ.). https://doi.org/10.48612/cgma/zm34-618u-7rxk

8. Suvorov VV, Markevich VYu, Goncharov AV, Pichugin AA, Myasnikov NI, Petukhov KV et al. Differentiated surgical tactics for abdominal trauma, accompanied by damage to the liver and spleen. Military Medical Journal. 2021;342(9):50–57. (In Russ.). https://doi.org/10.52424/00269050_2021_342_9_50

9. Feoktistov VA, Lukina AA, Baidaliev ER, Taubaev ER, Major T. Traumatic liver injuries complicated by bleeding. Research and development of young scientists : Collection of materials of the XVII International Youth Scientific and Practical Conference, Novosibirsk, March 10 – 07, 2017. Under the general editorship of S.S. Chernov. Novosibirsk: Limited Liability Company “Center for the Development of Scientific Cooperation”. 2017;62–65. (In Russ.)

10. Masljakov VV, Barsukov VG, Cherednik AA. The main reasons for diagnostic mistakes at patients with the closed injuries of the parenchymatous bodies received as a result of road and transport incident. The Journal of scientific articles “Health and Education Millennium”. 2016;18(8):51–53. (In Russ.)

11. Podoluzhny VI, Radionov IA, Pelz VA, Startsev AB, Krasnov KA, Shatalin VA. Traumatic liver injury. Polytrauma. 2023;1:34–38. (In Russ.). https://doi.org/10.24412/1819-1495-2023-1-34-38

12. Masljakov VV, Barsukov VG, Cherednik AA. Immediate results of treatment of closed liver injuries resulting from road traffic accidents. Bulletin of the medical Institute “REAVIZ”: rehabilitation, doctor and health. 2016;4(24):45-51. (In Russ.)

13. Voynovskiy AE, Novikov GA, Semenenko IA, Kuptsov AS. Use of Innovative Technologies in the Treatment of Patients with Severe Concomitant Injury with Liver Damage. Meditsina katastrof = Disaster Medicine. 2021;4:61–63 (In Russ.). https://doi.org/10.33266/2070-1004-2021-4-61-63

14. Dyukov AK, Zemlyanoi VP, Sigua BV. X-ray endovascular surgical technologies in the treatment of focal traumatic liver injuries in closed abdominal trauma. Health. Medical ecology. The science. 2020;1(80):44–45. (In Russ.). https://doi.org/10.5281/zenodo.824425

15. Pothmann CEM, Sprengel K, Alkadhi H, Osterhoff G, Allemann F, Jentzsch T, et al. Abdominalverletzungen des polytraumatisierten Erwachsenen: Systematischer Überblick [Abdominal injuries in polytraumatized adults: Systematic review]. Unfallchirurg. 2018;121(2):159–173. German. PMID: 29350250 https://doi.org/10.1007/s00113-017-0456-5

16. Afifi I, Abayazeed S, El-Menyar A, Abdelrahman H, Peralta R, Al-Thani H. Blunt liver trauma: a descriptive analysis from a level I trauma center. BMC Surg. 2018;18(1):42. PMID: 29914487 https://doi.org/10.1186/s12893-018-0369-4

17. Reva VA, Samokhvalov IM, Golovko KP, Nosov AM, Demchenko KN, Petrov AN et al. Temporary endovascular prosthetics of the inferior vena cava in case of damage to its subhepatic segment is an innovative approach to the treatment of severe liver injuries. Military Medical Journal. 2021;342(3):26–31. (In Russ.)

18. Styazhkina SN, Khakimov RA, Yudina AV. Description of a blunt extensive liver injury in a clinical case. Innovation. The science. Education. 2021;33:1930-1934. (In Russ.)

19. Zargaran D, Zargaran A, Khan M. Systematic Review of the Management of Retro-Hepatic Inferior Vena Cava Injuries. Open Access Emerg Med. 2020;12:163–171. PMID: 32617024 https://doi.org/10.2147/OAEM.S247380

20. Maskin SS, Ermolaeva NK, Aleksandrov VV, Matyukhin VV. Combined blunt abdominal injury: standardization of the therapeutic and diagnostic approach from the standpoint of evidence-based medicine: Monograph. Volgograd: Publishing House of VolgSMU, 2021. (In Russ.)

21. Еrmolov AS, Blagovestnov DA, Gulyayev AA, Yartsev PA, Andreyev VG, Smolyar AN, et al. Injuries to parenchymal organs of the abdominal cavity in abdominal trauma: textbook. Moscow: GBOU DPO RMAPO, 2016;137. (In Russ.)

22. Shapkin YuG, Chalyk YuV, Stekolnikov NYu, Kuzyaev TR. Packing in surgical treatment of severe liver damage. Polytrauma. 2020;1:18–22. (In Russ.). https://doi.org/10.24411/1819-1495-2020-10003

23. Maskin SS, Aleksandrov VV, Matyukhin VV, Ermolaeva NK. Blunt liver injuries: the algorithm of surgeon’s actions in a first-level trauma center. Polytrauma. 2020;2:84–91. (In Russ.). https://doi.org/10.24411/1819-1495-2020-10024

24. Parkhisenko YuA, Vorontsov AK, Vorontsov KE, Bezaltynnykh AA. Analysis of the results of the surgical treatment of patients with trauma of the liver. Perspectives of Science & Education. 2018;1(31):245–250. (In Russ.)

25. Shchegolev AA, Al Sabunchi OA, Tovmasyan RS, Muradyan TG, Kogan MA, Sheikhov TG. Blunt abdominal trauma: surgeon’s tactics for liver and spleen injuries. Moscow medicine. 2016;S1(12):211. (In Russ.)

26. Bondarev GA, Lipatov VA, Severinov DA, Saakyan AR. Intraoperative Tactics of Local Surgical Hemostasis in Injuries and Planned Operations on the Parenchymal Organs of the Abdominal Cavity. Journal of Experimental and Clinical Surgery. 2020;13:3:268–278. (In Russ.). https://doi.org/10.18499/2070-478X-2020-13-3-268-278

27. Shabunin AV, Bedin VV, Grekov DN, Tavobilov MM, Curkan VA, Drozdov PA. Differentiated approach in the treatment of patients with liver damage in abdominal trauma. Moscow Surgical Journal. 2016;4(50):60–64. (In Russ.)

28. Aleksandrov VV, Maskin SS, Ermolayeva NK, Matyukhin VV. Non-Operative Management of Blunt Abdominal and Retroperitoneal Solid Organs Trauma, of Retroperitoneal Hemorrage — Indications, Methodology and Necessity. Russian Sklifosovsky Journal of Emergency Medical Care. 2021;10(3):540–548. (In Russ.). https://doi.org/10.23934/2223-9022-2021-10-3-540-548

29. Coccolini F, Coimbra R, Ordonez C, Kluger Y, Vega F, Moore EE, et al. Liver trauma: WSES 2020 guidelines. World J Emerg Surg. 2020;15(1):24. PMID: 32228707 https://doi.org/10.1186/s13017-020-00302-7

30. Coccolini F, Catena F, Moore EE, Ivatury R, Biffl W, Peitzman A, et al. WSES classification and guidelines for liver trauma. World J Emerg Surg. 2016;11:50. PMID: 27766112 https://doi.org/10.1186/s13017-016-0105-2

31. Rogal ML, Smolyar AN, Dzhagraev KR. Treatment of closed liver injury. Trauma 2017: Multidisciplinary approach : Collection of abstracts of the International Conference, Moscow, 03-04 November 2017. Editorial board: A.V. Skoroglyadov [et al.]. – Moscow: Publishing and Printing Center “Scientific Book”. 2017;320–321. (In Russ.)

32. Green CS, Bulger EM, Kwan SW. Outcomes and complications of angioembolization for hepatic trauma: A systematic review of the literature. J Trauma Acute Care Surg. 2016;80(3):529–537. PMID: 26670113https://doi.org/10.1097/TA.0000000000000942

33. Tarchouli M, Elabsi M, Njoumi N, Essarghini M, Echarrab M, Chkoff MR. Liver trauma: What current management? Hepatobiliary Pancreat Dis Int. 2018;17(1):39–44. PMID: 29428102 https://doi.org/10.1016/j.hbpd.2018.01.013

34. Barbier L, Calmels M, Lagadec M, Gauss T, Abback PS, Cauchy F, et al. Can we refine the management of blunt liver trauma? J Visc Surg. 2019;156(1):23–29. PMID: 29622405 https://doi.org/10.1016/j.jviscsurg.2018.03.013

35. Schembari E, Sofia M, Latteri S, Pesce A, Palumbo V, Mannino M, et al. Blunt liver trauma: effectiveness and evolution of non-operative management (NOM) in 145 consecutive cases. Updates Surg. 2020;72(4):1065–1071. PMID: 32851597 https://10.1007/s13304-020-00861-z

36. Kumar V, Mishra B, Joshi MK, Purushothaman V, Agarwal H, Anwer M, et al. Early hospital discharge following non-operative management of blunt liver and splenic trauma: A pilot randomized controlled trial. Injury. 2021;52(2):260–265. PMID: 33041017 https://doi.org/10.1016/j.injury.2020.10.013

37. Keizer AA, Arkenbosch JHC, Kong VY, Hoencamp R, Bruce JL, Smith MTD, et al. Blunt and Penetrating Liver Trauma have Similar Outcomes in the Modern Era. Scand J Surg. 2021;110(2):208–213. PMID: 32693697 https://doi.org/10.1177/1457496920921649

38. Pankratov AA, Izrailov RE, Chudnykh SM, Khat’kov IE. Non-operative management of blunt abdominal trauma: positive predictors. Almanac of Clinical Medicine. 2017;45(5):416–422. (In Russ.). https://doi.org/10.18786/2072-0505-2017-45-5-416-422

39. Sinha Y, Khajanchi MU, Prajapati RP, Dharap S, Soni KD, Kumar V, et al. Management of liver trauma in urban university hospitals in India: an observational multicentre cohort study. World J Emerg Surg. 2020;15(1):58. PMID: 33059728 https://doi.org/10.1186/s13017-020-00338-9

40. Liagkos G, Spyropoulos C, Tsourouflis G, Papadopoulos A, Ioannides P, Vagianos C. Successful non-operative management of blunt abdominal trauma in highly selective cases: A safe and effective choice. Ulus Travma Acil Cerrahi Derg. 2018;24(2):104–109. PMID: 29569680 https://doi.org/10.5505/tjtes.2017.83404

41. Cimbanassi S, Chiara O, Leppaniemi A, Henry S, Scalea TM, Shanmuganathan K et al. Nonoperative management of abdominal solid-organ injuries following blunt trauma in adults: Results from an International Consensus Conference. J Trauma Acute Care Surg. 2018;84(3):517–531. PMID: 29261593 https://doi.org/10.1097/TA.0000000000001774

42. Leppäniemi A. Nonoperative management of solid abdominal organ injuries: From past to present. Scand J Surg. 2019;108(2):95–100. PMID: 30832550 https://doi.org/10.1177/1457496919833220

43. Sigua BV, Karnaukhov AS, Zemlyanoy VP, Begishev OB. Osobennosti diagnostiki i lecheniya sochetannoy travmy golovy i zhivota s povrezhdeniem pecheni v usloviyakh mnogoprofil’nogo statsionara. In: Innovatsionnye tekhnologii diagnostiki i lecheniya v mnogoprofil’nom meditsinskom statsionare: materialy Vserossiyskoy nauchno-prakticheskoy konferentsii, posvyashchennoy 30-letiyu so dnya obrazovaniya SPb GBUZ “Gorodskaya mnogoprofil’naya bol’nitsa №2”, (Sankt-Peterburg, 5–6 iyulya 2023 g.). Saint Petersburg: VMA im. S.M. Kirova Publ.; 2023. pp. 354-359. (In Russ.)

44. Yartsev PA, Levitskiy VD, Rogal’ MM. Ispol’zovanie minimal’no invazivnykh tekhnologiy v lechenii abdominal’noy travmy. Moscow: RAN Publ., 2019. (In Russ.)

45. Karsanov AM, Maskin SS, Aleksandrov VV, Matyukhin VV. Diagnostic and therapeutic possibilities of laparoscopic and robotic technologies in blunt abdominal trauma (systematic review of the literature). Grekov’s Bulletin of Surgery. 2022;181(4):88–97. (In Russ.). https://doi.org/10.24884/0042-4625-2022-181-4-88-97

46. Maystrenko AN, Bezhin AI, Lipatov VA, Chizhikov GM. Determination of blood loss volume in modeling injuries of parenchymatous organs with application of new hemostatic agents in an experiment. Innova. 2018; 2(11):12–14. (In Russ.). https://doi.org/10.21626/innova/2018.2/03

47. Morse DC, Silva E, Bartrom J, Young K, Bass EJ, Potter D, et al. Improved bleeding scores using Gelfoam(®) Powder with incremental concentrations of bovine thrombin in a swine liver lesion model. J Thromb Thrombolysis. 2016;42(3):352–359. PMID: 27334382 https://doi.org/10.1007/s11239-016-1388-6

48. Kurdyaev IG, Umerov AKh, Grishin AV, Shabanov TV, Chernikov EhV. Local Hemostasis Method in Case of Superficial Lesion of Parenchymatous Organs of Abdomen: Experimental-Clinical Research. Disaster Medicine. 2017;100(4):51–54. (In Russ.)

49. Küçükaslan H, Tayar S, Oğuz Ş, Topaloglu S, Geze Saatci S, et al. The role of liver resection in the management of severe blunt liver trauma. Ulus Travma Acil Cerrahi Derg. 2022;29(1):122–129. PMID: 36588513 https://doi.org/10.14744/tjtes.2021.89678

50. Fabian TC, Croce MA, Stanford GG, Payne LW, Mangiante EC, Voeller GR, et al. Factors affecting morbidity following hepatic trauma. A prospective analysis of 482 injuries. Ann Surg. 1991;213(6):540–547; discussion 548. PMID: 2039284 https://doi.org/10.1097/00000658-199106000-00003

51. Martellotto S, Melot C, Raux M, Chereau N, Menegaux F. Depacked patients who underwent a shortened perihepatic packing for severe blunt liver trauma have a high survival rate: 20 years of experience in a level I trauma center. Surgeon. 2022;20(3):e20–e25. PMID: 34154925 https://doi.org/10.1016/j.surge.2021.04.012

52. Segura-Sampedro JJ, Pineño-Flores C, Craus-Miguel A, Morales-Soriano R, González-Argente FX. New hemostatic device for grade IV-V liver injury in porcine model: a proof of concept. World J Emerg Surg. 2019;14:58. PMID: 31889989 https://doi.org/10.1186/s13017-019-0277-7

53. Odishelashvili GD, Pakhnov DV, Pakhnova TV. Surgical management in severe traumatic liver injury. Caspian Journal of Medicine and Pharmacy. 2023;4(1):75–79. (In Russ.). https://doi.org/10.29039/2712-8164-2023-1-75-79

54. Ishida K, Katayama Y, Kitamura T, Hirose T, Ojima M, Nakao S, et al. Relationship between in-hospital mortality and abdominal angiography among patients with blunt liver injuries: a propensity score-matching from a nationwide trauma registry of Japan. Acute Med Surg. 2022;9(1):e725. PMID: 35059219 https://doi.org/10.1002/ams2.725

55. Ivanecz A, Pivec V, Ilijevec B, Rudolf S, Potrč S. Laparoscopic anatomical liver resection after complex blunt liver trauma: a case report. Surg Case Rep. 2018;4(1):25. PMID: 29572673 https://doi.org/10.1186/s40792-018-0432-5

56. Yorov UU, Akhmedov A, Salimzoda NF, Gaibov AG. Efficiency of application of endosurgical methods in diagnostics and treatments of combined and multiple abdominal injuries. Health care of Tajikistan. 2018;4:5–8. (In Russ.)

57. Elkbuli A, Ehrhardt JD Jr, McKenney M, Boneva D. Successful utilization of angioembolization and delayed laparoscopy in the management of grade 5 hepatic laceration: Case report and literature review. Int J Surg Case Rep. 2019;59:19–22. PMID: 31100482 https://doi.org/10.1016/j.ijscr.2019.05.011

58. Yazici H, Verdiyev O. Laparoscopic Approach to Severe Liver Injury in a Patient with Blunt Abdominal Trauma. Cureus. 2023;15(3):e36568. PMID: 37095823 https://doi.org/10.7759/cureus.36568

59. Charyshkin AL, Gafiullov MR, Demin VP. The results of the diagnosis of posttraumatic hepatitis in patients with closed liver injury. Modern problems of science and education. 2016;2;131. (In Russ.)

60. Iacobellis F, Scaglione M, Brillantino A, Scuderi MG, Giurazza F, Grassi R, et al. The additional value of the arterial phase in the CT assessment of liver vascular injuries after high-energy blunt trauma. Emerg Radiol. 2019;26(6):647–654. PMID: 31444680 https://doi.org/10.1007/s10140-019-01714-y

61. Malloum Boukar K, Moore L, Tardif PA, Soltana K, Yanchar N, Kortbeek J, et al. Value of repeat CT for nonoperative management of patients with blunt liver and spleen injury: a systematic review. Eur J Trauma Emerg Surg. 2021;47(6):1753–1761. PMID: 33484276 https://doi.org/10.1007/s00068-020-01584-x

62. Segalini E, Morello A, Leati G, Di Saverio S, Aseni P. Primary angioembolization in liver trauma: major hepatic necrosis as a severe complication of a minimally invasive treatment-a narrative review. Updates Surg. 2022;74(5):1511–1519. PMID: 36059024 https://doi.org/10.1007/s13304-022-01372-9

63. Virdis F, Podda M, Di Saverio S, Kumar J, Bini R, Pilasi C, et al. Clinical outcomes of non-operative management and clinical observation in non-angioembolised hepatic trauma: A systematic review of the literature. Chin J Traumatol. 2022;25(5):257–263. PMID: 35487854 https://doi.org/10.1016/j.cjtee.2022.04.004

64. Chu M, How N, Laviolette A, Bilic M, Tang J, Khalid M, et al. Delayed laparoscopic peritoneal washout in non-operative management of blunt abdominal trauma: a scoping review. World J Emerg Surg. 2022;17(1):37. PMID: 35780121 https://doi.org/10.1186/s13017-022-00441-z

65. Ruscelli P, Gemini A, Rimini M, Santella S, Candelari R, Rosati M, et al. The role of grade of injury in non-operative management of blunt hepatic and splenic trauma: Case series from a multicenter experience. Medicine (Baltimore). 2019;98(35):e16746. PMID: 31464904 https://doi.org/10.1097/MD.0000000000016746

66. Hazelton JP, Choron RL, Dodson GM, Gerritsen JA, Khan S, VanOrdenet KE, et al. Comparison of atriocaval shunting with perihepatic packing versus perihepatic packing alone for retrohepatic vena cava injuries in a swine model. Injury. 2015;46(9):1759–1764. PMID: 25900557 https://doi:10.1016/j.injury.2015.04.014

67. Chun Y, Cho SK, Clark WC, Wagner WR, Gu X, Tevar AD, et al. A retrievable rescue stent graft and radiofrequency positioning for rapid control of noncompressible hemorrhage. J Trauma Acute Care Surg. 2017;83(2):249–255. PMID: 28452874 https://doi.org/10.1097/TA.0000000000001534

68. Wikström MB, Krantz J, Hörer TM, Nilsson KF. Resuscitative endovascular balloon occlusion of the inferior vena cava is made hemodynamically possible by concomitant endovascular balloon occlusion of the aorta-A porcine study. J Trauma Acute Care Surg. 2020;88(1):160–168. PMID: 31397743 https://doi.org/10.1097/TA.0000000000002467