Liver trauma in 446 patients.

A total of 446 patients with liver trauma were treated over a 10-year period: 295 (66%) had penetrating injuries (204 stab wounds, 91 gunshot wounds) and 151 (34%) blunt trauma. Seventeen patients died during resuscitation before laparotomy. In 344 (80%) of the 429 patients who underwent laparotomy, injuries were managed by simple methods such as temporary packing, diathermy, sutures or vessel ligation. Eighty-five patients (18%) had complex injuries and underwent one or more of the following procedures to control bleeding: hepatotomy and intrahepatic vessel suture (28), resectional debridement (31), lobar resection (17), perihepatic packing and relaparotomy (25), total hepatic isolation (4) or atriocaval shunt (1). Overall mortality was 54 (12.1%) and was greatest after blunt injury (27%) compared with gunshot (11%) and stab wounds (2%). Mortality was directly attributable to the abdominal injury in 39 patients, 22 of whom died from uncontrolled haemorrhage. Complications occurred in 151 of 392 survivors (38.5%) and correlated with type and severity of the liver injury (31% in stab wounds, 43% in gunshot wounds, 57% in blunt injuries) and the number of associated injuries. As many as 80% of liver injuries can be managed by simple surgical techniques. In major liver injuries perihepatic packing may be life-saving, allowing control of bleeding before a logical sequential strategy is instituted to isolate and repair the injury.