Complex therapy for hepatic trauma

Background: Hepatic trauma is a major cause of death in abdominal injury patients. This study was aimed at investigating the outcome of management of 197 patients presenting with hepatic injuries.
Methods: This was a retrospective study of all patients treated for hepatic injuries at Oilu Hospital from January 1980 to January 1999 and at Dodoma Regional Hospital from January 1990 to January 2001.Seven patients were treated non-surgically while 188 had surgery. Conservative treatment included absolute bed rest, replacement and stabilization of the blood capacity, anti-inflammation drugs and styptic. Surgical procedures for patients with grade III and IV hepatic trauma included packing with omentum and repair of liver lacerations, debridment or irregular hepatectomy under Pringle's maneuver, perihepatic tamponade with or without selective ligation of hepatic artery and post hepatic vein repair together with T-tube and perihepatic drainage.
Results: There were 30 deaths (15.3% mortality rate). All the seven patients treated conservatively survived. The main cause of death was exsanguination with or without coagulopathy, multiple organ failure (MOSF) and associated injuries.
Conc1usion:The basic operative principles for liver injuries are thorough debridment and haemostasis, elimination of bile leakage and unobstructed drainage.