At 12:00 noon on January 24, 2012 (the second day of the Lunar New Year), a 3-year-old 6-month-old child was admitted to the Intensive Care Unit of Qingyuan People’s Hospital with a car crush injury to the chest and abdomen. The child was admitted with poor mental status, indifferent expression, unresponsiveness, heart rate of 160 beats/min, unstable blood pressure (maintained by blood pressure-raising drugs) and a progressive downward trend, slightly elevated abdomen, and non-coagulable fluid drawn by abdominal puncture. While explaining the condition to the child’s family, explaining the necessity and feasibility of surgical treatment and possible complications; while working with colleagues in the intensive care unit to improve preoperative preparations and notify the operating room of the emergency surgery. After everyone’s intense and orderly preparation, the child entered the operating room at 12:45 pm. Through intraoperative investigation, the child was found to have a ruptured spleen, a completely exposed right kidney due to the rupture of the right anterior pericardium, and a ruptured right adrenal gland adjacent to the liver. The ruptured liver was about 14 cm long and 6 cm deep, involving 50% of the liver parenchyma, and about 600 ml of blood was aspirated from the abdominal cavity during surgery. With rich clinical experience and skillful surgical skills, the treatment team finally completed the liver rupture repair, right adrenal gland repair, splenectomy and cholecystectomy successfully after three hours of struggle! Postoperative diagnosis: ruptured liver and spleen, contusion of right adrenal gland, contusion of both lungs, contusion of kidney, hemorrhagic shock and hemorrhagic anemia. After the operation, through 3 weeks of individualized treatment, the child recovered smoothly and was discharged from the hospital without postoperative complications. The mortality rate of hepatic trauma was reported by Locher et al. to be as high as 14-40% and 31-76% in severe hepatic trauma. ～However, the mortality rate of severe liver trauma is still as high as 50%. According to statistics, hemorrhage, infection and combined injury are the top 3 causes of death in liver trauma, among which hemorrhage is the main cause of death in liver trauma. According to the cause of injury, liver trauma is generally divided into open injury and closed injury. Open injuries generally include stab wounds and firearm injuries. Closed abdominal injuries are mostly blunt injuries, mainly due to impact and crush, and are commonly seen in road traffic accidents, building collapses, and occasionally in falls from height, sports injuries or assault injuries. Because closed abdominal injuries are often combined with other organ injuries in addition to liver trauma, and there are no signs of injury on the surface of the abdomen, diagnosis is relatively difficult, resulting in delayed treatment, so blunt injuries are more dangerous, and the morbidity and mortality rate is often higher than that of open injuries. Patients usually have a clear history of trauma to the right side of the chest and abdomen, and awake patients complain of pain in the right upper abdomen, sometimes radiating to the right shoulder. They feel thirsty, nausea and vomiting. Signs of hepatic trauma are mainly hypovolemic shock and peritonitis. Individual patients with intra-abdominal hemorrhage may also present with abdominal distension. The clinical manifestations of hepatic trauma are inconsistent due to different causes of injury. Whether a closed abdominal injury is combined with liver injury involves the question of whether or not to operate openly, thus requiring a high degree of diagnostic accuracy. When the diagnosis is in doubt, laparotomy, abdominal lavage and other ancillary tests can mostly assist in the diagnosis. In the case of improving condition and stable vital signs, necessary tests are done and further treatment plans are made after the diagnosis is clear. And for those with severe shock can be actively operated while transfusing blood and replenishing fluids to expand the volume. You cannot wait until the shock is corrected before dealing with the injury, which often loses the opportunity to save the patient’s life. Treatment For hemodynamically stable can be used non-surgical treatment; unstable should be immediately sent to the operating room for surgical treatment, depending on the degree of liver injury and systemic status, to take a comprehensive treatment approach to stop bleeding, and repair hepatobiliary injury. Surgical treatment modalities include: simple suturing, hepatic dissection and debridement, selective bile duct vascular ligation, large omental tamponade suturing, partial hepatectomy, gauze tamponade, hepatic artery ligation, liver transplantation, selective arterial embolization, and laparoscopic treatment. Since no single technique can save all liver trauma, comprehensive treatment is now the standard approach for the treatment of complex liver trauma. Complications associated with liver trauma include hemorrhagic, infectious, biliary complications and abdominal compartment syndrome (hepatic necrosis, liver abscess and bile leak, infection, rebleeding, bile leak, biliary hemorrhage, MODS), together with a series of blows such as trauma, blood loss and surgery, which put the organism in a state of stress. Therefore, postoperative liver injury does not indicate the end of resuscitation, but the beginning of systemic treatment. Untimely correction after surgery can produce a variety of complications and further deterioration of the injury. The treatment plan should be promptly adjusted according to the changes in the patient’s condition after surgery, and individualized treatment including intensive care, nutritional support, anti-infection, hemostasis, prevention of stress ulcers, and patency drainage should be used. Due to the complexity of hepatic trauma, we suggest that for hepatic trauma requiring surgical treatment, we should go to a hospital with appropriate specialties or a large trauma center as soon as the condition permits to avoid delaying treatment.