[Hepatic trauma].

Abstract

OBJECTIVE: To evaluate the causes, degree of injury and localization of the hepatic trauma in thoracic-abdominal injuries: surgical solution and its results, as well as to explain the liver damages according to the cause of the injury. ABSTRACT: Patients with thoracic-abdominal trauma often evidence liver lesions that must be treated quickly and promptly. METHOD: Retrospective study of the cases of liver trauma undergoing surgery during the years 1995/2000 at the Jos Casimiro Ulloa , Emergency Hospital in Lima, Peru. RESULTS: 164 patients underwent surgery with a mortality rate of 13.4% (22). Injuries were caused by direct contusion in 58% of the cases and by aggression in 42% of the cases. The liver was repaired with suture in 121 cases, by tamponing in 40 cases, by hepatectomy in 1 case and no treatment in 2 cases. There were 38 re-interventions. The relation between the degrees of liver injuries and mortality were: 1 Degree: 9 cases, with no deaths, 2 Degree: 97 cases with 4 deaths (4.1%); 3rd Degree: 37 cases with 2 deaths (5%), 4 Degree: 12 cases with 7 deaths (58%); 5 Degree: 9 cases with 9 deaths (100%). CONCLUSION: In our experience, liver complications in thoracic-abdominal injuries are high,. Total mortality was 13.6%, of which 70% were due to a closed wound and 30% due to an open wound. Resuscitation, vital support, quick and timely surgery, whichever the technique used to reduce liver bleeding, gives positive results. Often the accompanying lesions determine the patient s evolution. The symptoms of liver injuries are predictable in cases of direct trauma or deceleration. In wounds inflicted by bullets or sharp and penetrating objects, the trajectory determines the damages to the anatomy.