Treatment of penetrating hepatic injuries: a retrospective analysis of 50 patients.
OBJECTIVE
The aim of this study was to determine the possibility of non-operative treatment via retrospective analysis of our patients.


METHODS
Fifty patients with penetrating hepatic injuries were examined retrospectively with respect to trauma scores, associated injuries, complications, and mortality parameters.


RESULTS
Thirteen injuries were caused by firearms, whereas 37 injuries were caused by stab wounds. Forty-three patients (86%) underwent laparotomy and 7 patients (14%) were monitored by CT and clinical findings (nonoperative group, NO group). The laparotomies were evaluated as non-therapeutic in 11 patients (22%) (NTL group) and therapeutic in 32 patients (64%) (TL group). The morbidity and mortality rates were 40 and 10%, respectively. RTS and ISS scores of the nonsurviving and the surviving patients were significantly different. The rates of major venous, grade IV-V hepatic injuries, and gunshot wounds were significantly higher in the nonsurviving patients when compared to the surviving patients.


CONCLUSIONS
Major venous and grade IV-V hepatic injuries were the primary factors determining mortality and these injuries generally occurred as a result of firearm injuries. NTL occurring at a rate of 22% would decrease to 2% if 'RTS <7' criteria was added to the hemodynamic instability and/or peritoneal irritation findings determining surgical candidacy.
Gonullu
D
D
Department of Surgery, Turkish Ministry of Health, Taksim Training and Research Hospital, Istanbul, Turkey. dogangonullu@yahoo.com
Koksoy
F N
FN
Ilgun
S
S
Demiray
O
O
Yucel
O
O
Yucel
T
T
D000293:Adolescent; D000328:Adult; D005260:Female; D006489:Hemostatic Techniques; D006801:Humans; D007813:Laparotomy; D008099:Liver / Q000000981:diagnostic imaging / Q000293:injuries* / Q000601:surgery; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D014057:Tomography, X-Ray Computed; D014421:Turkey / Q000453:epidemiology; D014948:Wounds, Gunshot / Q000000981:diagnostic imaging / Q000401:mortality / Q000628:therapy*; D014951:Wounds, Stab / Q000000981:diagnostic imaging / Q000401:mortality / Q000628:therapy*; D055815:Young Adult