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May 1968

Management of Blunt Trauma to the Liver and Hepatic Veins

Author Affiliations

San Francisco
From the Department of Surgery, University of California School of Medicine and San Francisco General Hospital, San Francisco.

Arch Surg. 1968;96(5):698-704. doi:10.1001/archsurg.1968.01330230006002

CURRENTLY accepted management of liver trauma outlined by Madding et al1 has reduced overall mortality from 60% prior to World War II2,3 to between 9% and 27%.4-6 To further reduce mortality the treatment of blunt liver injuries must be improved.7 The mortality from penetrating wounds has been relatively low, ranging from 0.8% to 14.3%,6,8 but blunt trauma has been reported to be fatal in 25% to 55% of recent series.8,9

Review of the experience at San Francisco General Hospital showed that hepatic vein injuries were a significant factor in the high mortality from blunt liver trauma. A new approach to management of hepatic vein injuries has been devised.

Material  From 1960 to 1966, 61 patients with liver injury were admitted to San Francisco General Hospital. Thirty-two patients had stab wounds, nine had gunshot wounds, and 20 had blunt trauma. The 47 males and 14