• 3-D printed model
• Liver wrapping
• Severe liver injury
• Surgical education

• Printing, Three-Dimensional
• Humans
• Liver/injuries
• Models, Anatomic
• Internship and Residency/methods
• Tomography, X-Ray Computed
• Clinical Competence
• Hemostatic Techniques
• Trauma Severity Indices

• Veins
• abdominal injuries
• liver

• Intra-abdominal abscess
• Liver trauma
• Management
• Operative

• Adult
• Humans
• Retrospective Studies
• Liver/surgery
• Liver/injuries
• Abdomen
• Abdominal Cavity
• Abdominal Abscess/epidemiology
• Abdominal Abscess/etiology
• Injury Severity Score
• Abdominal Injuries/complications
• Abdominal Injuries/surgery
• Trauma Centers

• Kidney injury
• Liver injury
• Nonoperative management
• Pediatric patients
• Spleen injury

• Humans
• Child
• Adolescent
• Retrospective Studies
• Spleen/injuries
• Accidents, Traffic
• Seat Belts/adverse effects
• Abdominal Injuries/diagnosis
• Abdominal Injuries/therapy
• Abdominal Injuries/etiology
• Wounds, Nonpenetrating/diagnosis
• Wounds, Nonpenetrating/therapy
• Wounds, Nonpenetrating/etiology

• blunt abdominal
• blunt liver trauma
• liver rupture
• liver trauma
• operative skills

Given its size and location, the liver is the third most injured organ by abdominal trauma. Thanks to recent advances, it is unanimously accepted that the non-operative management is the current mainstay of treatment for hemodynamically stable patients. However, those patients with hemodynamic instability that generally present with severe liver trauma associated with major vascular lesions will require surgical management. Moreover, an associated injury of the main bile ducts makes surgery compulsory even in the case of hemodynamic stability, thereby imposing therapeutic challenges in the tertiary referral hepato-bilio-pancreatic centers’ setting.

We present the case of a 38-year-old male patient with The American Association for the Surgery of Trauma grade V liver injury and an associated right branch of portal vein and common bile duct avulsion, due to a crush polytrauma. The patient was referred to the nearest emergency hospital and because of the hemorrhagic shock, damage control surgery was performed by means of ligation of the right portal vein branch and right hepatic artery, and hemostatic packing. Afterwards, the patient was referred immediately to our tertiary hepato-bilio-pancreatic center. We performed depacking, a right hepatectomy and Roux-en-Y hepaticojejunostomy. On the 9^th postoperative day, the patient developed a high output anastomotic bile leak that required a redo of the cholangiojejunostomy. The postoperative period was marked by a surgical incision site of incomplete evisceration that was managed non-operatively by negative wound pressure. The follow-up was optimal, with no complications at 55 mo.

In conclusion, the current case clearly supports that a favorable outcome in severe liver trauma with associated vascular and biliary injuries is achieved thru proper therapeutic management, conducted in a tertiary referral hepato-bilio-pancreatic center, where a stepwise and complex surgical approach is mandatory.

• Severe
• Liver
• Trauma
• Avulsion
• Right portal vein
• Common bile duct
• Case report

• Appendicitis
• Children
• Emergency
• Emergency surgery
• Injury
• Pediatric surgery
• Pediatric trauma
• Trauma surgery
• WSES

• Blast injuries
• Case reports
• Hemoperitoneum
• Metal fragment
• Penetrating liver injury

Traumatic abdominal injuries are life-threatening emergencies frequently seen in the Emergency Department (ED). The most common is liver trauma, which accounts for approximately 5% of all ED admissions for trauma. The management of blunt liver trauma has evolved significantly over the past few decades and, according to the injury’s severity, it may require massive resuscitation, radiological procedures, endoscopy, or surgery. Patients admitted to the ED with blunt abdominal trauma require a multidisciplinary evaluation, including emergency physicians, surgeons, radiologists, and anesthetists, who must promptly identify the extent of the injury to prevent serious complications. In case of a patient’s death, the execution of a forensic examination carried out with a multidisciplinary approach (radiological, macroscopic, and histological) is essential to understand the cause of death and to correlate the extent of the injuries to the possibility of survival to be able to manage any medico-legal disputes. This manuscript aims to collect the most up-to-date evidence regarding the management of hepatic trauma in the emergency room and to explore radiological findings and medico-legal implications.

Liver involvement after abdominal blunt trauma must be expected, and in up to 30% of cases, spleen, kidney, and pancreas injuries may coexist. Whenever hemodynamics conditions do not contraindicate the overcoming of the ancient dogma according to which exploratory laparotomy should be performed after every major abdominal trauma, a CT scan has to clarify the liver lesions so as to determine the optimal management strategy. Except for complete vascular avulsion, no liver trauma grade precludes nonoperative management. Every attempt to treat the injured liver by avoiding a strong surgical approach may be considered. Each time, a nonoperative management (NOM) consisting of a basic “wait and see” attitude combined with systemic support and blood replacement are inadequate. Embolization should be considered to stop the bleeding. Percutaneous drainage of collections, endoscopic retrograde cholangiopancreatography (ERCP) with papilla sphincterotomy or stent placement and percutaneous transhepatic biliary drainage (PTBD) may avoid, or at least delay, surgical reconstruction or resection until systemic and hepatic inflammatory remodeling are resolved. The pathophysiological principle sustaining these leanings is based on the opportunity to limit the further release of cell debris fragments acting as damage-associated molecular patterns (DAMPs) and the following stress response associated with the consequent immune suppression after trauma. The main goal will be a faster recovery combined with limited cell death of the liver through the ischemic events that may directly follow the trauma, exacerbated by hemostatic procedures and surgery, in order to reduce the gross distortion of a regenerated liver.

To assess relationships between abdominal angiography and outcomes in adults with blunt liver injuries.

A retrospective observational study carried out from January 2004 to December 2018. Adult blunt‐trauma patients with AAST grade Ⅲ–Ⅴ were analyzed with in‐hospital mortality as the primary outcome using propensity‐score‐(PS) matching to seek associations with abdominal angiography findings.

A total of 1,821 patients were included, of which 854 had available abdominal angiography data (AA+) and 967 did not (AA−). From these, 562 patients were selected from each group by propensity score matching. In‐hospital mortality was found to be lower in the AA+ than in the AA− group (15.1% [87/562] versus 25.4% [143/562]; odds ratio 0.544, 95% confidence interval 0.398–0.739).

Abdominal angiography is shown to be of benefit for adult patients with blunt liver injury in terms of their lower in‐hospital mortality.

• ABTHERA
• Blunt hepatic injury
• Children
• Damage control surgery

• Drains
• Intra-abdominal abscess
• Liver trauma

Transcatheter arterial embolization (TAE) is the first-line nonsurgical treatment for severe blunt liver injury in patients, whereas operative management (OM) is recommended for hemodynamically unstable patients. This study investigated the comparative efficacy of TAE in hemodynamically unstable patients who responded to initial infusion therapy.

This retrospective study enrolled patients with severe blunt liver injuries, which were of grades III–V according to the American Association for the Surgery of Trauma Organ Injury Scale (OIS). Patients who responded to initial infusion therapy underwent computed tomography to determine the treatment plan. A shock index > 1, despite undergoing initial infusion therapy, was defined as hemodynamic instability. We compared the clinical outcomes and mortality rates between patients who received OM and those who underwent TAE.

Sixty-two patients were included (eight and 54 who underwent OM and TAE, respectively; mean injury severity score, 26.6). The overall in-hospital mortality rate was 6% (13% OM vs. 6% TAE, p = 0.50), and the hemodynamic instability was 35% (88% OM vs. 28% TAE, p < 0.01). Hemodynamically unstable patients who underwent TAE had 7% in-hospital mortality and 7% clinical failure. Logistic regression analysis showed that the treatment choice was not a predictor of outcome, whereas hemodynamic instability was an independent predictor of intensive care unit stay ≥7 days (odds ratio [OR], 3.80; p = 0.05) and massive blood transfusion (OR, 7.25; p = 0.01); OIS grades IV–V were predictors of complications (OR, 6.61; p < 0.01).

TAE in hemodynamically unstable patients who responded to initial infusion therapy to some extent has acceptable in-hospital mortality and clinical failure rates. Hemodynamic instability and OIS, but not treatment choice, affected the clinical outcomes.

• Angioembolization
• Blunt trauma
• Hepatic trauma
• Interventional radiology
• Liver injury
• Non-operative management
• Transcatheter arterial embolization

Adequate hemostasis during surgical procedures is essential for successful patient outcomes and reduced healthcare resource utilization. Topical hemostatic agents can act as catalysts for the clotting cascade or as a scaffold to promote platelet activation or aggregation. Although an ever-increasing number of topical absorbable hemostatic agents are now available for perioperative use, health care providers are disadvantaged by the lack of comparative data on feasibility, clinical effectiveness, advantages, and limitations of each in specific surgical settings. This knowledge is important for appropriate product choice when patient characteristics, type of surgical procedure, type of bleeding, and product availability may differ widely. This manuscript provides the first comprehensive overview of Avitene™ Microfibrillar Collagen Hemostat (MCH), a bovine collagen-based absorbable hemostat that has been widely used for over four decades in the United States and abroad. MCH is indicated as an adjunct to hemostasis across a broad spectrum of surgical specialties and has been shown to achieve hemostasis with positive patient outcomes and a favorable safety profile in many applications, including hepatic, orthopedic, splenic, oral, and otolaryngologic surgery. Although published clinical data regarding the use of MCH in cardiovascular surgery is limited, evidence suggests moderate use in this specialty. The information contained in this systematic review will help health care providers understand the clinical use and effectiveness of the product to determine appropriate use in differing bleeding scenarios across multiple surgical specialties. Future studies may include comparative functional and cost analyses to explore the economic advantages of using absorbable hemostatic agents compared with each other or with conventional techniques of hemostasis, when appropriate.

• Avitene
• hemorrhage
• hemostasis
• microfibrillar collagen
• surgery
• topical

• Blunt hepatic injury (BSI)
• Computed tomography (CT)
• Liver parenchymal disruption index (LPDI) deep learning (DL)
• Quantitative imaging

• Adult
• Decision Trees
• Deep Learning
• Humans
• Liver/diagnostic imaging
• Retrospective Studies
• Tomography, X-Ray Computed

• K08 EB027141 NIBIB NIH HHS

• blunt trauma
• general surgery
• hollow viscus injury
• trauma

• liver
• wound and injuries
• abdominal injuries
• hospitalization time
• fígado
• ferimento e lesões
• traumatismos abdominais
• tempo de internação

• Adult
• Firearms
• Hospitalization
• Humans
• Injury Severity Score
• Length of Stay
• Liver/injuries
• Liver/surgery
• Male
• Retrospective Studies
• Trauma Centers
• Wounds, Gunshot

• liver fibrosis
• non-alcoholic fatty liver disease
• non-alcoholic steatohepatitis

• Adult
• Aged
• Animals
• Base Sequence
• Biomarkers/blood
• Disease Models, Animal
• Disease Progression
• Female
• Gene Expression Profiling
• Humans
• Liver/metabolism
• Liver Cirrhosis/blood
• Male
• Mice, Inbred BALB C
• Middle Aged
• Non-alcoholic Fatty Liver Disease/blood
• RNA, Transfer/blood
• RNA, Transfer/chemistry
• RNA, Transfer/genetics
• Up-Regulation/genetics
• Young Adult
• Mice

• National Natural Science Foundation of China
• Natural Science Foundation of Hunan Province
• the Xiangya Hospital Foundation for Young Scholars
• the Scientific Research Project of Hunan Health Commission

• Epidemiology of liver injury
• Injury
• Liver injury
• Management
• Non-operative management

•

GIA stapler can be effectively used for rapid non-anatomical resection of the liver in trauma.

Liver injury occurs in approximately 5% of all trauma admissions. There are many traditional ways of controlling hemorrhage from the liver and here we report a case in which a GIA 75 stapler was successfully used to manage Grade IV liver injury in a hemodynamically unstable patient.

45 years old policeman presented in the emergency, after sustaining a gunshot injury to his abdomen. At presentation, he was hemodynamically unstable and had a single entry wound in the epigastrium. He was rushed to the operating room (OR) for exploratory laparotomy which revealed a shattered left lobe of the liver. Gastrointestinal anastomosis 75 stapler device was used for non-anatomical left segmentectomy (segments I and II). Perihepatic packing was done and the patient shifted to the surgical intensive care unit (SICU). He was re-explored within 24 h. No active bleeding was seen after the packs were removed and the abdomen was closed. The next day he was moved out of SICU and was discharged on the 10th day of admission.

The concept of damage control surgery rests on quick control of life-threatening bleeding and a GIA stapler can be effectively used for rapid non-anatomical resection of the liver in trauma. This can prevent the depletion of physiological reserves and the life-threatening death triad.

GIA stapler device is an effective, safe, and rapidly deployable tool for managing high-grade liver injury in a hemodynamically unstable patient.

• Gastrointestinal anastomosis stapler
• Hemodynamically unstable
• Liver injury
• Liver resection

Incisional hernias are a very common condition and they still are considered to be a surgical challenge due to their recurrence rate. Smoking, obesity and age are risk factors for developing these abdominal wall defects. Despite recent advances in hernia repairs, the recurrence rates of hernias did not significantly diminished, even after the introduction of meshes. The aim of this article is to report a case of a ventral incisional hernia in a 37-year-old man and its successful treatment with a procedure known as the Alcino-Lázaro technique repair. This procedure has been shown to be very effective in incisional hernias, especially in obese patients. Furthermore, it is as cheap as it is reliable, since it can be performed without technological aid or expensive materials (mesh); thus, patients in low-income countries can greatly benefit from this procedure.

• Incisional hernia
• surgery
• trauma
• ventral hernia

Liver injuries represent one of the most frequent life-threatening injuries in trauma patients. In determining the optimal management strategy, the anatomic injury, the hemodynamic status, and the associated injuries should be taken into consideration. Liver trauma approach may require non-operative or operative management with the intent to restore the homeostasis and the normal physiology. The management of liver trauma should be multidisciplinary including trauma surgeons, interventional radiologists, and emergency and ICU physicians. The aim of this paper is to present the World Society of Emergency Surgery (WSES) liver trauma management guidelines.

• Adult
• Classification
• Guidelines
• Hemorrhage
• Intensive care
• Interventional
• Liver trauma
• Minor
• Moderate
• Non-operative management
• Operative management
• Pediatric
• Radiology
• Severe
• Surgery

• embolization
• hepatic
• injury
• interventional radiology
• liver trauma

The aim of our study was to examine the possible effect of steatosis and fibrosis on the blunt force vulnerability of human liver tissue. 3.5 × 3.5 × 2-cm-sized liver tissue blocks were removed from 135 cadavers. All specimens underwent microscopical analysis. The tissue samples were put into a test stand, and a metal rod with a square-shaped head was pushed against the capsular surface. The force (Pmax) causing liver rupture was measured and registered with a Mecmesin AFG-500 force gauge. Six groups were formed according to the histological appearance of the liver tissue: intact (group 1), mild steatosis (group 2), moderate steatosis (group 3), severe steatosis (group 4), fibrosis (group 5), and cirrhosis (group 6). The average Pmax value was 34.1 N in intact liver samples (range from 18.1 to 60.8 N, SD ± 8.7), 45.1 N in mild steatosis (range from 24.2 to 79.8 N SD ± 12.6), 55.4 N in moderate steatosis (range from 28.9 to 92.5 N, SD ± 16.0), 57.6 N in severe steatosis (range from 39.8 to 71.5 N, SD ± 11.9), 63.7 N in fibrosis (range from 37.8 to 112.2 N, SD ± 19.5), and 87.1 N in the case of definite cirrhosis (range from 52.7 to 162.7 N, 30.3). The Pmax values were significantly higher in samples with visible structural change than in intact liver sample (p = 0.023, 0.001, 0.009, 0.0001, 0.0001 between group 1 and groups 2 to 6 respectively). Significant difference was found between mild steatosis (group 2) and cirrhosis (group 6) (p = 0.0001), but the difference between mild, moderate, and severe steatosis (groups 2, 3, and 4) was not significant. Our study demonstrated that contrary to what is expected as received wisdom dictates, the diseases of the parenchyma (steatosis and presence of fibrosis) positively correlate with the blunt force resistance of the liver tissue.

• Blunt force injuries
• Cirrhosis
• Forensic pathology
• Forensics
• Liver
• Steatosis

The liver is the most injured organ following abdominal trauma. Uncontrolled bleeding remains the main cause of early liver injury-related death, with a mortality rate of 50–54% in the first 24 h after admission and with 80% of operative deaths. Packing and reoperation account for the increased survival in severe liver trauma, and they are recommended for severe liver injuries (grades IV–V).

Perihepatic packing can lead to several potential complications. An excessive packing can cause complications due to abdominal compartment syndrome, while a soft packing may be ineffective, and thus, bleeding can continue inadvertently with the consequent hypovolemic shock and potentially death.

We designed a new vacuum-based device to perform perihepatic packing without the negative side-effects of the classic technique. We conducted a prospective pilot feasibility study in a porcine model. We compared the traditional perihepatic packing (PHP) (n = 2) with the new VacBagPack device (VBP) (n = 2).

Both pigs survived with the new device and showed an equivalent outcome to the one that survived in the traditional technique group. Blood tests were similar too. This suggests that VBP could be at least as effective as traditional PHP.

We establish a first step towards the development of a new packing device. A new study with a bigger sample size still in pigs will be conducted. Also, an industrial model of the device is currently in production.

• Abdominal trauma
• Damage control
• Hemostatic device
• Liver injury

A widespread shift to non-operative management (NOM) for blunt hepatic and splenic injuries has been observed in most centers worldwide. Furthermore, many countries introduced safety measures to systematically reduce severe traffic and leisure sports injuries. This study aims to evaluate the effect of these nationwide implementations on individual patient characteristics and outcomes through a time-trend analysis over 17 years in an Austrian high-volume trauma center.

A retrospective review of all emergency trauma patients admitted to the Medical University of Innsbruck from 2000 to 2016. Injury severity, clinical data on admission, operative and non-operative treatment parameters, complications, and in-hospital mortality were evaluated.

In total, 731 patients were treated with blunt hepatic and/or splenic injuries. Among these, 368 had a liver injury, 280 splenic injury, and 83 combined hepatic/splenic injury. Initial NOM was performed in 82.6% of all patients (93.5% in hepatic and 71.8% in splenic injuries) with a success rate of 96.7%. The secondary failure rate of NOM was 3.3% and remained consistent over 17 years (p = 0.515). In terms of injury severity, we observed a reduction over time, resulting in an overall mortality rate of 4.8% and 3.5% in the NOM group (decreasing from 7.5 to 1.9% and from 5.6 to 1.3%, respectively). These outcomes confirmed an improved utilization of the NOM approach.

Our cohort represents one of the largest Central European single-center experiences available in the literature. NOM is the standard of care for blunt hepatic and splenic injuries and successful in > 96% of all patients. This rate was quite constant over 17 years (p = 0.515). Overall, national and regional safety measures resulted in a significantly decreased severity of observed injury patterns and deaths due to blunt hepatic or splenic trauma. Although surgery is nowadays only applied in about one third of splenic injury patients in our center, these numbers might further decrease by intensified application of interventional radiology and modern coagulation management.

The online version of this article (10.1186/s13017-019-0249-y) contains supplementary material, which is available to authorized users.

• Blunt abdominal trauma
• Non-operative management
• Safety measures

• Angioembolization
• Interventional radiology
• Liver trauma
• Non operative management

Non-operative management (NOM) of blunt hepatic and splenic injuries has become popular in haemodynamically stable adult patients, despite uncertainty about efficacy, patient selection, and details of management. Up-to-date strategies and practical recommendations are presented.

A selective literature search was conducted in PubMed and the Cochrane Library (1989–2016).

No randomized clinical trial was found. Non-randomized controlled trials and large retrospective and prospective series dominate. Few systematic reviews and meta-analyses are available. NOM of selected patients with blunt liver and spleen injuries is associated with low morbidity and mortality. Only data of limited evidence are available on intensity and duration of patient monitoring, repeat imaging, antithrombotic prophylaxis and return to normal activity. There is high-level evidence on early mobilisation and post-splenectomy vaccination.

NOM of blunt liver or spleen injuries is a worldwide trend, but the literature does not provide high-grade evidence for this strategy.

• Abdominal trauma
• Classification
• Diagnostic imaging
• Multiple trauma
• Sports

Liver trauma is an important source of morbidity and mortality worldwide. A timely detection and precise evaluation of traumatic liver injury and the bleeding site is necessary. There is a need to develop better imaging modalities of hepatic injuries to increase the sensitivity of ultrasonic imaging techniques for sites of hemorrhage caused by cracks. In this study, we conduct an in silico simulation of liver crack detection and delineation using an ultrasonic shear wave imaging (USWI) based method.

We simulate the generation and propagation of the shear wave in a liver tissue medium having a crack using COMSOL. Ultrasound radio frequency (RF) signal synthesis and the two-dimensional speckle tracking algorithm are applied to simulate USWI in a medium with randomly distributed scatterers. Crack detection is performed using the directional filter and the edge detection algorithm rather than the conventional inversion algorithm. Cracks with varied sizes and locations are studied with our method and the crack localization results are compared with the given crack.

Our pilot simulation study shows that, by using USWI combined with a directional filter cum edge detection technique, the near-end edge of the crack can be detected in all the three cracks that we studied. The detection errors are within 5%. For a crack of 1.6 mm thickness, little shear wave can pass through it and the far-end edge of the crack cannot be detected. The detected crack lengths using USWI are all slightly shorter than the actual crack length. The robustness of our method in detecting a straight crack, a curved crack and a subtle crack of 0.5 mm thickness is demonstrated.

In this paper, we simulate the use of a USWI based method for the detection and delineation of the crack in liver. The in silico simulation helps to improve understanding and interpretation of USWI measurements in a physical scattered liver medium with a crack. This pilot study provides a basis for improved insights in future crack detection studies in a tissue phantom or liver.

• Directional filter
• Edge detection
• Liver crack
• Speckle tracking
• Ultrasonic shear wave imaging

• Arterial bleeding
• Cyanoacrylate glue
• Embolization
• Gastrointestinal bleeding
• Outcomes
• Rectus sheath hematoma

• Blunt abdominal trauma
• Hollow viscus injury
• Trauma laparotomy

• Blast injuries
• Damage control strategy
• Hemorrhagic shock
• Lack of resources
• Terrorist attack trauma

To compare a novel, fully synthetic, polyurethane based glue (MAR-1) to fibrin sealant in a partial liver resection rat model.

After 50% resection of the lateral left liver lobe in male Wistar rats (n = 7/group/time point), MAR-1, Fibrin or NaCl was applied. After 14, 21 and 90 postoperative days, sealant degradation, intra-abdominal adhesions were scored, and histological examination of liver tissue was performed.

(Mean ± SEM) (MAR-1 vs Fibrin vs NaCl). Bleeding mass was significantly higher in NaCl (3.36 ± 0.51 g) compared to MAR-1 (1.44 ± 0.40 g) and Fibrin (1.16 ± 0.32 g). At 14 and 90 d, bleeding time was significantly lower in MAR-1 (6.00 ± 0.9 s; 13.57 ± 3.22 s) and Fibrin (3.00 ± 0.44 s; 22.2 ± 9.75 s) compared to NaCl (158.16 ± 11.36 s; 127.5 ± 23.3 s). ALT levels were significantly higher in MAR-1 (27.66 ± 1 U/L) compared to Fibrin (24.16 ± 0.98 U/L) and NaCl (23.85 ± 0.80 U/L). Intrabdominal adhesions were significantly lower in MAR-1 (11.22% ± 5.5%) compared to NaCl (58.57% ± 11.83%). Degradation of the glue was observed and MAR-1 showed almost no traces of glue in the abdominal cavity as compared to the Fibrin (10% ± 5% 14 d; 7% ± 3% 21 d). Survival showed no significant differences between the groups.

Compared to Fibrin, MAR-1 showed similar hemostatic properties, no adverse effects, and is biocompatible. Further studies on adhesion strength and biodegradability of synthetic sealants are warranted.

• MAR-1
• Fibrin
• Liver resection
• Hemostasis
• Polyurethane

• hemostasis
• liver resection
• medical adhesive
• polyurethane/polyurea resin

Complex pelvic injuries are among the most dangerous and deadly trauma related lesions. Different classification systems exist, some are based on the mechanism of injury, some on anatomic patterns and some are focusing on the resulting instability requiring operative fixation. The optimal treatment strategy, however, should keep into consideration the hemodynamic status, the anatomic impairment of pelvic ring function and the associated injuries. The management of pelvic trauma patients aims definitively to restore the homeostasis and the normal physiopathology associated to the mechanical stability of the pelvic ring. Thus the management of pelvic trauma must be multidisciplinary and should be ultimately based on the physiology of the patient and the anatomy of the injury. This paper presents the World Society of Emergency Surgery (WSES) classification of pelvic trauma and the management Guidelines.

• ABO
• Angiography
• External fixation
• Guidelines
• Injury
• Internal fixation
• Management
• Mechanic
• Pelvic
• Pelvic ring fractures
• Preperitoneal pelvic packing
• REBOA
• Trauma
• X-ray

The severity of liver injuries has been universally classified according to the American Association for the Surgery of Trauma (AAST) grading scale. In determining the optimal treatment strategy, however, the haemodynamic status and associated injuries should be considered. Thus the management of liver trauma is ultimately based on the anatomy of the injury and the physiology of the patient. This paper presents the World Society of Emergency Surgery (WSES) classification of liver trauma and the management Guidelines.

• Classification
• Guidelines
• Hemorrage
• Liver trauma
• Minor
• Moderate
• Non-operative management
• Operative management
• Severe
• Surgery