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.
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