Research Article| Volume 117, ISSUE 4, P359-364, April 1995

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Gunshot injuries of the liver: The Baragwanath experience

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      Background. This study comprised 304 patients with gunshot injuries of the liver, many of which from high-velocity firearms. The purpose of this study is to evaluate our management policy in gunshot injuries of the liver in light of our recent wider experience.
      Methods. All grade I and II injuries and most grade III injuries were managed by simple operative measures, without postoperative mortality directly related to the liver trauma.
      Results. Grade III, IV, and V injuries had 8.5%, 52%, and 16% resectional débridement rates and 8.5%, 38%, and 84% perihepatic packing rates, respectively. In the resectional débridement group the postoperative mortality rate was 15% (half the deaths were directly caused by the hepatic injury). The postoperative mortality rate in the perihepatic packing group was 31.5% of which 45% of deaths were due to ongoing bleeding, 27.5% to sepsis, and 27.5% to associated trauma. The septic complications were less common when packs were removed early.
      Conclusions. We suggest that resectional débridement and perihepatic packing should be liberally applied in the most severe grade III, most grade IV, and grade V gunshot injuries of the liver and that perihepatic packing should be removed as early as the physiologic derangements are corrected. Our experience with grade VI injuries is very limited, and their management should be studied in larger series.
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        • Demetriades D
        • Rabinowitz B
        • Sofianos C
        Non-operative management of penetrating liver injuries: a prospective study.
        Br J Surg. 1986; : 736-737
        • Pantanowitz D
        Modern surgery in Africa: the Baragwanath experience. Southern Book Publishers, Johannesburg1988: 48-54
        • Moore EE
        • Shackford SR
        • Pachter HL
        • et al.
        Organ injury scaling: spleen, liver and kidney.
        J Trauma. 1989; 29: 1664-1666
        • Harris LM
        • Booth FVM
        • Hesseh JM
        Liver laceration: a marker of severe but sometimes subtle intra-abdominal injuries in adults.
        J Trauma. 1991; 31: 894-899
        • Pringle JH
        Notes on the arrest of hepatic haemorrhage due to trauma.
        Ann Surg. 1908; 48: 541-548
        • Ochner MG
        • Jaffin JH
        • Golocovsky M
        • Jones RC
        Major hepatic trauma.
        Surg Clin North Am. 1993; 73: 337-351
        • Pachter HL
        • Spencer FC
        • Hofstetter SR
        • Coppa GF
        Experience with finger fracture technique to achieve intrahepatic haemostasis in 75 patients with severe injuries to the liver.
        Ann Surg. 1983; 197: 771-778
        • Pachter HL
        • Spencer FC
        • Hofstetter SR
        • Liang HG
        • Coppa GF
        Significant trends in the treatment of hepatic trauma.
        Ann Surg. 1992; 215: 492-502
        • Huguet C
        • Nordlinger B
        • Bloch P
        • Cornard J
        Tolerance of the human liver to prolonged normothermic ischemia: a biological study of 20 patients submitted to extensive hepatectomy.
        Arch Surg. 1978; 113: 1448-1451
        • Walt AJ
        Surgical management of hepatic trauma.
        in: McDermott WV Surgery of the liver. Blackwell Scientific Publications, Boston1988: 417
        • Stain SC
        • Yellin AE
        • Donovan AJ
        Hepatic trauma.
        Arch Surg. 1988; 123: 1251-1255
        • Feliciano DV
        • Mattox KL
        • Jordan Jr, GL
        • Burch JM
        • Bitondo CG
        • Cruse PA
        Management of 1000 consecutive cases of hepatic trauma.
        Ann Surg. 1986; 204: 438-445
        • Balasegaram DM
        Hepatic resection for trauma.
        Adv Surg. 1984; 17: 129-170
        • Bluet MK
        • Woltering E
        • Adkins RB
        Management of penetrating hepatic injuries.
        Am Surg. 1984; 50: 132-142
        • Mays ET
        Lobar dearterialization for exsanguinating wounds of the liver.
        J Trauma. 1972; 12: 397-407
        • Levin A
        • Gover P
        • Nance FC
        Surgical restraint in the management of hepatic injury: a review of the Charity Hospital experience.
        J Trauma. 1978; 18: 399-404
        • Poulos E
        Hepatic resection for massive liver injury.
        Ann Surg. 1963; 157: 525-531
        • Byrd WM
        • McAfee D
        Emergency hepatic lobectomy in massive injury of the liver.
        Surg Gynecol Obstet. 1961; 113: 103-105
        • Trunkey DD
        • Shires GT
        • McClellaud R
        Management of liver trauma in 811 consecutive patients.
        Ann Surg. 1974; 179: 722-728
        • Madding GF
        • Peniston WH
        Liver haemostasis.
        Surg Gynecol Obstet. 1957; 104: 417-424
        • Lucas CE
        • Ledgerwood AM
        Prospective evaluation of haemostatic techniques for liver injuries.
        J Trauma. 1976; 16: 442-451
        • Walt AJ
        The mythology of liver trauma—or Babel revisited.
        Am J Surg. 1978; 135: 12-18
        • Saifi D
        • Fortune JB
        • Graca L
        • Shah DM
        Benefits of intra-abdominal pack placement for the management of nonmechanical haemorrhage.
        Arch Surg. 1990; 125: 119-122
        • Keige JEJ
        • Bornman PC
        • Terblanche J
        Therapeutic perihepatic packing in complex liver trauma.
        Br J Surg. 1992; 79: 43-46
        • Cué JI
        • Cryer HG
        • Miller FB
        • Richardson DJ
        • Polk HC
        Packing and planned re-exploration for hepatic and retro peritoneal haemorrhage: critical refinements of a useful technique.
        J Trauma. 1990; 30: 1007-1013
        • Reed LR
        • Merrell RC
        • Meyers WC
        • Fisher RP
        Continuing evolution in the approach to severe liver trauma.
        Ann Surg. 1992; 216: 524-538
        • Jacobson LE
        • Kirton OC
        • Gomez GA
        The use of an absorbable mesh wrap in the management of major hepatic injuries.
        Surgery. 1992; 111: 455-461
        • Gilmore D
        • McSwain NE
        • Browden IW
        Hepatic trauma: to drain or not to drain.
        J Trauma. 1987; 27: 898-902
        • Bender JS
        • Geller ER
        • Wilson RF
        Intra-abdominal sepsis following liver trauma.
        J Trauma. 1989; 29: 1140-1146
        • Flint LM
        • Mays ET
        • Aaron W
        • et al.
        Selectivity in the management of liver trauma.
        Ann Surg. 1977; 185: 613-618
        • Yanaga K
        • Kenematsu T
        • Suojimachi K
        • et al.
        Intraperitoneal septic complications after hepatectomy.
        Ann Surg. 1986; 203: 147-152