Critical Decisions in Liver Trauma

Abstract

The causes of liver trauma in 604 cases treated at Detroit General Hospital in the past 8½ years were 290 knifings, 249 gunshot wounds, and 65 blunt injuries. Most stab wounds and gunshot wounds were treated by simple suture or drainage or both; some gunshot wounds require debridement. The death rate was 1.7% for stab wounds, 18% for gunshot wounds, and 27.6% for blunt injury. A combination of preoperative and intraoperative hemorrhage from the abdominal aorta or inferior vena cava caused most of the deaths followed by intra-abdominal sepsis and pulmonary failure in patients with associated colon injury. A prospective randomized drainage study shows increased morbidity in those patients with controlled extrahepatic biliary drainage compared to those patients without such drainage. Problems related to through-and-through gunshot wounds, postoperative gastric mucosal bleeding, posthepatectomy coagulation deficiencies are discussed and early postoperative respiratory insufficiency.