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August 1970

Critical Decisions in Liver TraumaExperience Based on 604 Cases

Author Affiliations

From the Robert S. Marx Surgical Laboratories and the Department of Surgery, Wayne State University School of Medicine; and Detroit General Hospital, Detroit.

Arch Surg. 1970;101(2):277-283. doi:10.1001/archsurg.1970.01340260181027

The causes of liver trauma in 604 cases treated at Detroit General Hospital in the past 8½ years were 290 knifings, 249 gunshot wounds, and 65 blunt injuries. Most stab wounds and gunshot wounds were treated by simple suture or drainage or both; some gunshot wounds require debridement. The death rate was 1.7% for stab wounds, 18% for gunshot wounds, and 27.6% for blunt injury. A combination of preoperative and intraoperative hemorrhage from the abdominal aorta or inferior vena cava caused most of the deaths followed by intra-abdominal sepsis and pulmonary failure in patients with associated colon injury. A prospective randomized drainage study shows increased morbidity in those patients with controlled extrahepatic biliary drainage compared to those patients without such drainage. Problems related to through-and-through gunshot wounds, postoperative gastric mucosal bleeding, posthepatectomy coagulation deficiencies are discussed and early postoperative respiratory insufficiency.