title: Complex Hepatic Injuries: an Audit from a Tertiary Center.
abstract: BACKGROUND
  Nonoperative management is being increasingly employed in the management of blunt hepatic injuries.
  
  
  METHODS
  We analyzed patients with complex hepatic injuries over a period of 10 years (1996-2006).
  
  
  RESULTS
  Two hundred and ten patients with blunt hepatic injury were admitted and 103 patients had complex liver injuries. The predominant mode of injury was road traffic accidents in 91.2%. The grade distribution of liver injuries was grade III (72.8%), grade IV (23.3%) and grade V (4.9%). Twenty-four patients (23.3%) underwent surgery for persistent hemodynamic instability, persistent fall in hemoglobin level, bile leaks and intra-abdominal collection with sepsis. Associated intra-abdominal injuries were present in 19.4%, and 58.4% had associated extra-abdominal injuries. The operative procedures included hepatectomy (1), suture hepatorraphy (12), T-tube drainage for bile duct injuries (5), perihepatic sponge and gel foam packing (9), liver abscess drainage (3), and resection and debridement of liver tissue in six patients. The mortality and morbidity in this series was 10.7 and 56.4%, respectively. Multiorgan failure was present in 5, single organ failure in 37, sepsis in 24, biliary complications in 16 and intra-abdominal collection in 17 patients. Endoscopic management for bile leaks was performed in five patients, image-guided pig-tail drainage for abscesses in 11 patients, while angioembolization was done in two patients for right hepatic artery bleed. The mortality was not significantly different in surgical and nonoperative groups but operated patients had significantly higher morbidity.
  
  
  CONCLUSIONS
  Complex liver injuries can be managed successfully with conservative treatment in majority, with low mortality and acceptable morbidity. Surgery is reserved for selected indications.
authors.affiliation: Department of General Surgery, Post Graduate Institute of Medical Education and Research, Chandigarh, India.
authors.forename: Thiagarajan
authors.initials: T
authors.lastname: Srinivasan
authors.affiliation: Department of General Surgery, Post Graduate Institute of Medical Education and Research, Chandigarh, India. jdwsjni@hotmail.com.|Department of General Surgery, Postgraduate Institute of Medical Education and Research, Chandigarh, 160012, India. jdwsjni@hotmail.com.
authors.forename: Jai D
authors.initials: JD
authors.lastname: Wig
authors.affiliation: Department of General Surgery, Post Graduate Institute of Medical Education and Research, Chandigarh, India.
authors.forename: Rajesh
authors.initials: R
authors.lastname: Gupta
authors.affiliation: Department of General Surgery, Post Graduate Institute of Medical Education and Research, Chandigarh, India.
authors.forename: Thakur D
authors.initials: TD
authors.lastname: Yadav
authors.affiliation: Department of General Surgery, Post Graduate Institute of Medical Education and Research, Chandigarh, India.
authors.forename: Rudra P
authors.initials: RP
authors.lastname: Doley
authors.affiliation: Department of General Surgery, Post Graduate Institute of Medical Education and Research, Chandigarh, India.
authors.forename: Ashwinikumar
authors.initials: A
authors.lastname: Kudari
authors.affiliation: Department of General Surgery, Post Graduate Institute of Medical Education and Research, Chandigarh, India.
authors.forename: Nedounsejiane
authors.initials: N
authors.lastname: Mandjiny
authors.affiliation: Department of Gastroenterology, Post Graduate Institute of Medical Education and Research, Chandigarh, India.
authors.forename: Rakesh
authors.initials: R
authors.lastname: Kochhar
keywords: Abdominal; Abdominal trauma; Evaluation of care (trauma data bases); General trauma; Multiple trauma; Polytrauma; Thorax and abdominal trauma; Trauma management and education