Severe hepatic trauma: A multi-center experience with 1,335 liver injuries

Thomas H. Cogbill, Ernest E. Moore, Gregory Jurkovich, David V. Feliciano, John A. Morris, Peter Mucha

Research output: Contribution to journalArticle

264 Scopus citations

Abstract

The experience of six regional trauma centers with severe hepatic trauma was reviewed to identify trends in management, mortality, and postoperative complications. During the 5-year period ending June 1987, 210 complex liver injuries were identified at laparotomy. There were 92 Class III, 59 Class IV, and 59 Class V injuries. Mechanism of injury was blunt in 101 (48%) patients and penetrating in 109 (52%). Shock was observed in 38%, 46%, and 85% of Class III, IV, and V patients, respectively. Emergency department thoracotomy was performed in 31 patients. There was only one (3%) survivor. Resuscitative operating room thoracotomy was performed in 34 patients with three (9%) survivors. Class III injuries were most frequently treated with hepatotomy and individual vessel ligation (41%) and deep liver suturing (25%). Class IV injuries were most often managed by resectional debridement (36%). Class V injuries required caval shunt placement in 38 (64%) patients. There were only four (10%) survivors after caval shunt placement. There were 20 (59%) survivors of 34 patients treated with packing placed as an adjunct after hepatic injury repair. There was no significant increase in the incidence of abscess formation after perihepatic packing. Routine peritoneal drainage was used in 94% of patients. Overall mortality rates for Class III, IV, and V injuries were 25%, 46%, and 80%, respectively (p < 0.01). Death rates due to the liver injury in Class III, IV, and V patients were 7%, 30%, and 66%, respectively (p < 0.01). Most frequent postoperative complications related to the hepatic injury in 129 patients who survived the initial operation were coagulopathy (16%), severe hyperpyrexia (11%), intra-abdominal abscess (9%), prolonged biliary leak (8%), late hemorrhage (7%), and hypoglycemia (4%).

Original languageEnglish (US)
Pages (from-to)1433-1438
Number of pages6
JournalJournal of Trauma - Injury, Infection and Critical Care
Volume28
Issue number10
DOIs
StatePublished - Jan 1 1988
Externally publishedYes

ASJC Scopus subject areas

  • Surgery
  • Critical Care and Intensive Care Medicine

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