Management of Hepatic Trauma in patients with abdominal firearm injuries

Abstract

Background: Firearm injuries to the abdomen are increasing in frequency worldwide. The objectives of this study were to evaluate the different ways of managing hepatic injuries due to firearm injuries and to make recommendations as to how various grades of hepatic trauma may be managed locally.

Material & Methods: It was a descriptive study conducted in Surgical B Ward Lady Reading Hospital Peshawar from July 2007 to January 2008. Sampling technique was convenient. After taking informed consent, all patients above 14 years age who presented to emergency department with firearm injury of abdomen, were included in this study. Patients with other types of abdominal injuries like stab and blunt trauma were excluded. The data was collected and analyzed.

Results: Out of 70 patients having firearm injury of abdomen, 20(28.57%) had hepatic trauma. Mean age of patients was 27.5+12.15 years and male to female ratio 3:1. Twelve (60%) patients were in state of shock. Right lobe was involved in 13(65%) and left lobe in 7(35%) patients. Eleven (55%) patients had Grade-I and II liver injuries, 5(25%) Grade III and 4(20%) Grade-IV liver injury. Operative procedures performed were hepatorraphy+spongeston application in 8(40%) patients and temporary perihepatic packing in 4(20%) patients. Complications occurred in 10(50%) patients.

Conclusion: Hepatic injury is common with abdominal firearm injury. Many of these patients get complications with a significant mortality. Conservative approach like perihepatic packing is the mainstay of treatment in Grade III and IV hepatic injuries.