Background: Equestrian sports are common outdoor activities that may carry a risk of liver injury. Due to the\nrelative infrequency of equestrian accidents the injury patterns and outcomes associated with liver trauma in these\npatients have not been well characterized.\nMethods: We examined our experience of the management of equestrian liver trauma in our regional\nhepatopancreaticobiliary unit at a tertiary referral center. The medical records of patients who sustained liver trauma\nsecondary to equestrian activities were analysed for parameters such as demographic data, liver function tests,\npatterns of injury, radiological findings, the need for intervention and outcomes.\nResults: 20 patients sustained liver trauma after falling from or being kicked by a horse. The majority of patients\nwere haemodynamically stable on admission. Alanine transaminase (ALT) levels were elevated in all patients and\nright-sided rib fractures were a frequently associated finding. CT demonstrated laceration of the liver in 12 patients,\ncontusion in 3 and subcapsular haematoma in 2. The right lobe of the liver was most commonly affected. Only two\npatients required laparotomy and liver resection; the remaining 18 were successfully managed conservatively.\nConclusions: The risk of liver injury following a horse kick or falling off a horse should not be overlooked. Early CT\nimaging is advised in these patients, particularly in the presence of high ALT levels and concomitant chest injuries\nsuch as rib fractures. Despite significant liver trauma, conservative management in the form of close observation,\nideally in a high-dependency setting, is often sufficient. Laparotomy is only rarely warranted and associated with a\nsignificantly higher risk of post-operative bile leaks.
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