Selective nonoperative management of liver gunshot injuries.
OBJECTIVE
Nonoperative management (NOM) of liver gunshot injuries is yet to gain general acceptance. The aim of this study was to assess the feasibility and safety of selective NOM of liver gunshot injuries.


METHODS
A prospective, protocol-driven study, which included all liver gunshot injuries admitted to a level I trauma center, was conducted over a 4-year period. Patients with right-sided thoracoabdominal, and right upper quadrant gunshot wounds with or without localized right upper quadrant tenderness underwent contrasted abdominal computed tomography scan evaluation to detect the presence of a liver injury. Patients with confirmed liver injuries were observed with serial clinical examinations. Outcome parameters included need for delayed laparotomy, complications, length of hospital stay, and survival.


RESULTS
During the study period, 63 patients with liver gunshot injuries were selected for NOM. The mean injury severity score was 19.6 (range, 4-34). Simple liver injuries (grades I and II) occurred in 26 (41.3%) patients and complex liver injuries (grades III, IV, and V) occurred in 37 (58.7%) patients. Associated injuries included 14 (22.2%) kidney, 44 (69.8%) diaphragm, 43 (68.3%) lung contusion, 42 (66.7%) hemothorax and/or pneuomothorax, and 21 (33.3%) rib fractures. Five patients required delayed laparotomy resulting in successful NOM rate of 92%. Complications included liver abscess (3), biliary fistula (3), retained hemothorax (4), and nosocomial pneumonia (5). The mean hospital stay was 6.1 (range, 3-23 days). There was no mortality.


CONCLUSIONS
The NOM of appropriately selected patients with liver gunshot injuries is feasible, safe, and effective, regardless of the liver injury severity.
Navsaria
Pradeep H
PH
Department of Surgery, Trauma Center, Groote Schuur Hospital, University of Cape Town, Cape Town, South Africa. pradeep.navsaria@uct.ac.za
Nicol
Andrew J
AJ
Krige
Jake E
JE
Edu
Sorin
S
D000007:Abdominal Injuries / Q000209:etiology / Q000401:mortality / Q000601:surgery*; D000900:Anti-Bacterial Agents / Q000008:administration & dosage; D001803:Blood Transfusion / Q000379:methods; D004322:Drainage / Q000379:methods; D005240:Feasibility Studies; D005260:Female; D017052:Hospital Mortality / Q000639:trends*; D006801:Humans; D015601:Injury Severity Score; D007813:Laparotomy / Q000379:methods; D007902:Length of Stay; D008099:Liver / Q000293:injuries*; D008297:Male; D018579:Patient Selection; D011379:Prognosis; D011446:Prospective Studies; D018570:Risk Assessment; D013019:South Africa; D015996:Survival Rate; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome; D014948:Wounds, Gunshot / Q000150:complications / Q000401:mortality / Q000601:surgery*
D000900:Anti-Bacterial Agents