The World Society of Emergency Surgery (WSES) reported a classification system for liver trauma, which is used to help guide management.
Patient selection: traumatic liver injury, blunt or penetrating
Indications for operative management with or without angioembolization:
(1) hemodynamic instability (WSES grade IV)
(2) free air
(3) localized thickened bowel wall
(4) peritonitis
(5) evisceration or impalement
(6) ineffective angioembolization
(7) severe head or spinal cord injuries (due to inability to reliably evaluate the clinical status)
(8) concomitant internal organ injury requiring surgery
Major hepatic resections should be avoided at first. Surgical goals should be control of hemorrhage and bile leaks, then to institute intensive resuscitation as soon as possible.
CT-scans with contrast should be performed in patients not undergoing operative management. Penetrating liver injuries suitable for non-operative management should be identified.
Non-operative management should only be considered when and where:
(1) the patient can be intensively monitored
(2) angiography is readily available
(3) blood products are readily available
(4) the operating room is readily available
