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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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Article info
Publication history
Accepted:
July 27,
1994
Identification
Copyright
© 1995 Mosby-Year Book, Inc. Published by Elsevier Inc.
