Serious Liver Trauma: Predictive Factors Of Therapeutic Choice And Prognostic Factors (About 65 Cases)

The charge of the severe hepatic traumas underwent a radical change from exclusive surgical treatment to non-operative-based conservative approach that benefited from the recent advances in the field of imagery as well as from the follow-up strategies of intensive care. A retrospective survey was carried out involving 65 patients treated for serious liver traumas in the surgical emergency department of Ibn Rochd university hospital of Casablanca. The aim of this study is to assess our act refunding SLT through the definition of the evolutionary, therapeutic, diagnostic, and epidemiological data. All  the penetrating and blunt SLT were included in this survey. The seriousness was defined by the hemodynamic instability and a lesion stage higher to III according to the MIRVIS rating. The clinical and paraclinical data as well as morbidity and mortality were analysed. Traffic accidents were the main cause of SLT our series is mainly composed of young male subjects (54 men, 83%). There were 86% of blunt traumas (56 cases) there was common polytrauma (78,5%). Ultrasound and CT scans were performed to most patients (respectively 83% and 78%). Fifty one patients had non operative treatment (78,5%) whereas 14 patients underwent surgery. This option was due to their hemodynamic instability and not the hepatic trauma lesion stage in the operative group, the evolution was complicate in 35,7% of the operated patients whereas in the non operative group the complications supervened only in 23,5% of the cases. The mortality rate was respectively 28,5% versus 7,8% for the non operative treatment the NOT of the SLT allowed to obtain satisfactory results despite the seriousness of  the hepatic lesions. It should be anted that the treatment choice was made mainly according to the hemodynamic condition and not to the radiological stage lesions A genuine and precocious agreement among the surgeon, the anesthesiologist and the   interventional radiologist allowed to avoid the server complications following SLT so that the injured patient who could be initially rescued manage to escape first hour complications, and ultimately recover.