The management of liver trauma.

The adult liver weighs around 1500 g and lies mainly in the right upper quadrant of the abdomen, immediately beneath the diaphragm [1]. The liver is the most commonly injured intra-abdominal organ and is found to be damaged in 30% of patients undergoing laparotomy for penetrating injuries and in 15–20% of laparotomies for blunt injuries [2]. An appreciation of basic liver anatomy is essential in understanding the mechanisms and consequences of hepatic trauma. The liver is divided into left and right lobes by an imaginary plane (the principal plane) which runs between the inferior vena cava (IVC) and the port hepatis and gall bladder. There is further subdivision into eight segments based on portal venous, hepatic arterial and bile duct anatomy, first described by Couinaud [3]. The majority of the liver is covered by visceral peritoneum which condenses to form the diaphragmatic attachments of the coronary, left and right triangular, and falciform ligaments. The vascular inflow to the liver is provided by the hepatic artery and portal vein, which lie with the common bile duct at the porta hepatis, and drainage is into the IVC via the three hepatic veins and also by small direct tributaries between the caudate lobe (segment 1) and the anterior surface of the IVC.