One hundred and sixty-six consecutive patients with closed hepatic injury admitted to Osaka University Hospital from 1966 to 1990 were reviewed to evaluate the surgical procedures for injured liver. Of the 166 patients, 37 died within 24 hours of initial management. Thirteen (35%) of the 37 died related to exsanguinating hemorrhage of liver injury. Emergency laparotomy required hepatic resection in all and revealed hepatic vein or retrohepatic caval injuries in 9. Eighty-nine of 129 patients who survived over 24 hours of initial management underwent emergency laparotomy. Twenty-two of the 129 died thereafter. Five (3 underwent lobectomy and 2 simple suture) died of liver injury-related complications. Perihepatic packing was performed in 5 and all except for 2 of brain death were alive. Most complications except for hemobilia were well resolved. CT scan study revealed profoundly radiating injuries closed to spine in 63% and suggested existence of hepatic vein or caval injury. Especially, 20 of 31 CT studies (65%) in conservative management of liver injury showed the same findings with intact capsule. These results support that exsanguinating hemorrhage from deep injury including hepatic vein or vena cava is the most lethal but can be controlled with liver packing in a similar mechanism to liver trauma in conservative management.