Liver packing for uncontrolled hemorrhage: a reappraisal.

The efficacy of liver packing for uncontrolled hemorrhage was assessed in 345 patients with hepatic injuries divided into two groups: Group I (1977-1980; n = 177), when packing was not used and Group II (1981-1985; n = 168) when the technique was employed. Despite similar clinical details, mortality from bleeding was unchanged (19.2% and 19.4% overall, and 63.7% and 61.7% for Grade IV, V, VI liver injuries). Packing was used in 14 patients who were in clinical coagulopathy after debridement-resection of the injured liver: eight patients (57%) expired from continued bleeding; five of the six survivors (83.3%) developed intra-abdominal abscesses despite early removal of the pack. The incidence of sepsis was significantly (p less than 0.002) increased as compared to that of 15 similar patients who had debridement-resection without packing. Liver packing, in our experience, has not altered the mortality from major hepatic trauma and appeared to increase the incidence of abdominal sepsis.