الفهرس 
Surgical Anatomy of the LiverOnly 14 pages are availabe for public view
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Abstract
The liver is the second most commonly injured organ in abdominal trauma, but damage to the liver is the most common cause of death after abdominal injury. The most common cause of liver injury is blunt abdominal trauma, which is secondary to motor vehicle accidents in most instances.
Besides physical examination, diagnosis of hepatic injury is guided by diagnostic peritoneal lavage, abdominal ultrasonography and abdominal CT.
Grades I-III injuries can safely be treated by conservative means with excellent results. However, complex hepatic injuries may often require surgical treatment ranging from packing to complex hemihepatectomy. Hence, for selection of appropriate therapeutic options, patients with hepatic injuries should be treated in a specialized institution.
The principles of operative treatment of hepatic trauma are the same, regardless of the severity of injury. They involve control of bleeding, removal of devitalized tissue and establishment of adequate drainage.
The spleen is the most common solid organ injured after BAT. Splenic injuries may occur in isolation or in association with other solid organ or hollow viscus injuries.
In the haemodynamically stable patient, diagnosis of blunt splenic injury may be suspected on diagnostic peritoneal lavage or focused assessment for sonography in trauma. However, CT provides a specific diagnosis and accurate grading in splenic trauma.
A decision to operate in splenic trauma is usually determined by the patient’s clinical status rather than imaging findings. Patients with certain imaging and clinical findings have traditionally been managed operatively rather than non-operatively. Imaging findings include active bleeding as evidenced by contrast extravasation, vascular injuries and high grade injury.
In all patients with splenic injury who are unstable, a total splenectomy should be performed, as well as in those patients with concomitant injury. In patients who are stable, every effort should be made to preserving part or all of the splenic tissue. Grade I or grade II injuries are generally treated with direct pressure, and limited packing. Grade III injuries (as well as persistent bleeding from grade II injuries) should be treated by formal splenorrhaphy, involving suture of the splenic parenchyma. This is best done over pledgets. Complex grade III or IV splenic injuries should be resected anatomically; with the segmental artery to the area of the spleen involved selectively ligated. Routine drainage is not advised (Rozycki et al., 2002).