The WSES (World Society of Emergency Surgery) grade for liver trauma classifies Grade IV (severe) hepatic injury as:
- A Parenchymal laceration 1–3 cm involving no trabecular vessels
- B Active bleeding from penetrating mechanism requiring damage control surgery regardless of haemodynamics
- C Parenchymal laceration >3 cm (AAST Grade III) with haemodynamic instability not responding to resuscitation, or juxtahepatic venous involvement (retrohepatic cava, main hepatic veins) regardless of haemodynamics ✓
- D Avulsion of the hepatoduodenal ligament with porta hepatis injury
Correct answer: C. Parenchymal laceration >3 cm (AAST Grade III) with haemodynamic instability not responding to resuscitation, or juxtahepatic venous involvement (retrohepatic cava, main hepatic veins) regardless of haemodynamics
Explanation
WSES liver trauma grade is based on both AAST morphological grade and haemodynamic status: WSES Grade I = AAST I–II haemodynamically stable; Grade II = AAST III stable; Grade III = AAST IV–V stable; Grade IV = AAST IV–V with haemodynamic instability OR AAST III–V unstable, OR any grade with juxtahepatic vascular injury (retrohepatic IVC, main hepatic veins). Grade IV requires damage control surgery/angioembolisation. This grading guides operative versus non-operative management decisions.
Reference: Bailey & Love's Short Practice of Surgery, 27th ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
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