The risk of liver injury from a horse kick or a fall should not be overlooked, according to British researchers.
The nine researchers investigated the cases of 20 patients who sustained liver trauma after either falling from a horse or being kicked.
The 20 patients ranged in age from 5 to 48, with the median being 22. Eighteen of them were female. Most were clinically stable on admission, they reported.
They found that right-sided rib fractures were a frequently associated finding. CT scans showed laceration of the liver in 12 patients, contusions in three and subcapsular haematoma in two.
The right lobe of the liver was most commonly affected.
Only two patients required surgical intervention. The remaining 18 were successfully managed conservatively. This was in keeping with studies on all-cause liver trauma, which demonstrated a trend towards non-operative management in haemodynamically stable patients, they said.
The researchers, whose findings have been published in the Journal of Trauma Management & Outcomes, said equestrian sports were common outdoor activities that may carry a risk of liver injury, but the injury patterns and outcomes associated with liver trauma in these patients have not been well characterised.
The risk of liver injury following a horse kick or falling off a horse should be considered, they said.
Early CT imaging was advised in these patients, they said, particularly in the presence of high alanine aminotransferase levels (which is indicative of liver damage), and chest injuries such as rib fractures.
“Despite significant liver trauma, conservative management in the form of close observation, ideally in a high-dependency setting, is often sufficient,” they said.
The researchers said the liver was the second most frequently injured intra-abdominal organ after the spleen in cases involving blunt abdominal trauma, despite its relatively well-protected location.
Horses, they noted, could weigh up to 1100 pounds and were capable of reaching speeds of up to 40 miles an hour.
“In addition a kick from a horses’ hoof has been shown to deliver over 10,000 Newtons of force to its victim or 1.8 times its body weight.
“It is not surprising therefore that although liver injuries constituted less than 1 percent of all equestrian injuries in several studies in the literature these injuries can be severe and carry life-threatening consequences for the patients involved.”
The study was carried out by Anita Balakrishnan, Reyad Abbadi, Kathryn Oakland, Saurabh Jamdar, Simon Harper, Neville Jamieson, Emmanual Huguet, Asif Jah and Raaj Praseedom.
Anita Balakrishnan, Reyad Abbadi, Kathryn Oakland, Saurabh Jamdar, Simon JF Harper, Neville V Jamieson, Emmanual L Huguet, Asif Jah1 and Raaj K Praseedom.
Outcomes following liver trauma in equestrian accidents
Journal of Trauma Management & Outcomes 2014, 8:13 doi:10.1186/1752-2897-8-13
The full study can be read online here.