Morbidity and mortality following major penetrating liver injuries
M. M. Knudson, R. C. Lim and E. W. Olcott
Department of Surgery, University of California, San Francisco.
OBJECTIVE: To establish the mortality and morbidity associated with major
penetrating liver injuries and to describe the nature and treatment of
complications related to these injuries. We postulated that there had been
a trend toward less radical initial surgery, as well as an increased
utilization of modern imaging techniques in both diagnosing and treating
postoperative complications following penetrating liver trauma. DESIGN: A
retrospective survey of medical records and radiology files. SETTING: A
university trauma center in an urban setting. PATIENTS: Of the 188 patients
admitted to our trauma center with penetrating liver trauma between April
1988 and December 1991, 36 had major liver trauma (grades 3 through 5) and
are described in this report. MAIN OUTCOME MEASURES: The mortality rate,
type of operative treatment, and the nature and treatment of complications
for each grade of major liver injury. RESULTS: The mortality rate from
major liver injuries was 17%. Surgical techniques employed primarily
consisted of the use of hemostatic agents and cautery, simple suturing,
direct vessel ligation, and packing. Fifty-two percent of the survivors had
major complications related to the liver injury itself, but only two
required operative therapy. The remaining patients were successfully
treated with interventional radiologic techniques. CONCLUSIONS: The
morbidity and mortality following major penetrating liver injuries remain
significant. The majority of hepatobiliary complications can be
successfully managed without further surgery but require the combined
efforts of the surgeon and interventional radiologist.
