Because of its large size, the liver is the most frequently injured solid abdominal organ secondary to both blunt and penetrating trauma. It can also be injured during removal of the gallbladder (cholecystectomy) and other right upper quadrant injuries.
The principles of surgical management of liver injury are the same whether the injury is slight or
massive. These are control of the bleeding, removing dead or devitalized tissue, and providing adequate drainage of the injured site.
Most liver injuries are minor and can be managed with simple procedures such as direct pressure, electrocautery, argon beam coagulation, topical agents (e.g., fibrin glue, surgicell), or simple suture or stapling. However, control of profuse bleeding from a deep or severe hepatic injury is a formidable task with a substantial risk of death.
In this setting of massive hemorrhage, most experienced liver surgeons today are opting for what is called “damage-control” surgery. This strategy uses the placement of many temporary gauze packs into the bleeding liver bed to stop or slow down the bleeding, rather than an attempt at immediate definitive repair. After the packs have been placed, the patient is taken to the intensive care unit, resuscitated with blood and coagulation factors, and warmed to allow for the naturally occuring clotting mechanisms to kick in. After 6-24 hours of stabilization, the patient is taken back to the operating room for attempt at definitive repair of the injury.