Hepatic Injuries at Al-Yarmouk Teaching Hospital Its Grades and Management

Hepatic Injuries at Al-Yarmouk Teaching Hospital Its Grades and Management

  • IMJ Iraqi Medical Journal
Keywords: Liver injury, Penetrating


Background: The liver is commonly damaged in blunt and penetrating abdominal trauma as well as in thoraco-abdominal injuries. It is best described using the classification of an organ injury scaling system.

Objectives: To evaluate the management of liver injury, its morbidity and mortality and discuss with other studies in the literature.

Methods: A prospective study included 125 patients who were admitted to Al-Yarmouk Teaching Hospital between January 1st, 2007 and December 31st, 2007 with liver trauma. Patients were analyzed regarding their demographic data, mechanism of injury, grades of their injury according to the Classification of the Organ Injury Scaling Committee of the American Association for the Surgery of Trauma (AAST), management of these injuries, associated injuries and follow up for morbidity and mortality.

Results: The majority of these patients were males (78.4%), with the young age group being more frequently injured (31.2% of patients were in their third decade). Penetrating injury was the cause in the majority (97.6%), and all were due to bullets or massive explosions. Grades I, II, and III were more common (forming 77% of patients), while the rest were in grades IV, V and VI. Primary suture was the commonest surgical method used in dealing with these liver injuries, and  was used mainly in patients with grades  I, II, and III, while elaborated surgical methods were applied to other advanced grades (IV, V and VI), such as packing, hepatotomy, resection, debridement; and vascular repair. Injuries to the diaphragm, lung and chest wall were the most commonly associated injuries. Wound infection was the commonest complication in patients, followed by chest infection, intraabdominal sepsis and biliary leak. The mortality rate was 19.2% (24 patients), of whom 9 patients (7.2%) died due to severe liver injury, while the other 15 (12%) died from their associated massive injuries and the multiple organ failure syndrome. The majority of the mortalities occurred in the high grade liver injuries (60% of patients with grade V died and 27.3% of those with grade IV died), while only 16% of patients with grades I, II, and III died.

Conclusion: Trauma remains an important cause of morbidity and mortality in liver injuries. The high mortality rate occurred in the high grade injuries, while the deaths which occurred in the low grade injuries were mainly due to the associated injuries. Grading of liver injuries by using the AAST grading system is a very useful tool for communication and comparison with other studies. Other modalities of surgical procedures need training, such as the atriocaval shunt and a mesh wrapping, as they can improve the results, if and available.

Keywords: Liver injury, Penetrating, High velocity, Missiles.

Iraqi Medical Journal Vol. 54, No. 1, June 2008; p. 1-9.

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