Abstract
During a 5-year period, 482 patients with liver injuries were studied prospectively: 65% resulted from penetrating and 35% from blunt injuries. The injuries were graded by the hepatic injury scale (grades I to VI); transfusion requirements and perihepatic abscesses correlated with increasing scores. Minor surgical techniques were needed in 338 patients and 144 patients required major techniques. Omental packing was used in 60% of the major injuries and yielded 7% mortality and 8% abscess rates. Gauze packs were used for management of 10% of major injuries and yielded 29% mortality and 30% abscess rates. The patients were randomized to no drain, closed suction, or sump drainage and respective perihepatic abscess rates were 6.7%, 3.5%, and 13% (p less than 0.03; suction compared to closed suction). Multivariate analysis demonstrated increasing abdominal trauma indices and transfusion requirements as well as sump drainage to be associated independently with perihepatic infection.
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Selected References
These references are in PubMed. This may not be the complete list of references from this article.
- Abraham E., Chang Y. H. Cellular and humoral bases of hemorrhage-induced depression of lymphocyte function. Crit Care Med. 1986 Feb;14(2):81–86. doi: 10.1097/00003246-198602000-00001. [DOI] [PubMed] [Google Scholar]
- Bender J. S., Geller E. R., Wilson R. F. Intra-abdominal sepsis following liver trauma. J Trauma. 1989 Aug;29(8):1140–1145. doi: 10.1097/00005373-198908000-00012. [DOI] [PubMed] [Google Scholar]
- Cogbill T. H., Moore E. E., Jurkovich G. J., Feliciano D. V., Morris J. A., Mucha P. Severe hepatic trauma: a multi-center experience with 1,335 liver injuries. J Trauma. 1988 Oct;28(10):1433–1438. [PubMed] [Google Scholar]
- DEBAKEY M. E., HOWARD J. M., MIKESKY W. E. Injuries of the liver in 300 consecutive patients. Surg Gynecol Obstet. 1956 Oct;103(4):323–337. [PubMed] [Google Scholar]
- Esquivel C. O., Bernardos A., Makowka L., Iwatsuki S., Gordon R. D., Starzl T. E. Liver replacement after massive hepatic trauma. J Trauma. 1987 Jul;27(7):800–802. doi: 10.1097/00005373-198707000-00020. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Fabian T. C., Kudsk K. A., Croce M. A., Payne L. W., Mangiante E. C., Voeller G. R., Britt L. G. Superiority of closed suction drainage for pancreatic trauma. A randomized, prospective study. Ann Surg. 1990 Jun;211(6):724–730. doi: 10.1097/00000658-199006000-00011. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Fabian T. C., Stone H. H. Arrest of severe liver hemorrhage by an omental pack. South Med J. 1980 Nov;73(11):1487–1490. doi: 10.1097/00007611-198011000-00021. [DOI] [PubMed] [Google Scholar]
- Feliciano D. V., Mattox K. L., Jordan G. L., Jr, Burch J. M., Bitondo C. G., Cruse P. A. Management of 1000 consecutive cases of hepatic trauma (1979-1984). Ann Surg. 1986 Oct;204(4):438–445. doi: 10.1097/00000658-198610000-00012. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Feliciano D. V., Mattox K. L., Jordan G. L., Jr Intra-abdominal packing for control of hepatic hemorrhage: a reappraisal. J Trauma. 1981 Apr;21(4):285–290. doi: 10.1097/00005373-198104000-00005. [DOI] [PubMed] [Google Scholar]
- Fischer R. P., O'Farrell K. A., Perry J. F. The value of peritoneal drains in the treatment of liver injuries. J Trauma. 1978 Jun;18(6):393–398. doi: 10.1097/00005373-197806000-00003. [DOI] [PubMed] [Google Scholar]
- Flint L. M., Jr, Polk H. C., Jr Selective hepatic artery ligation: limitations and failures. J Trauma. 1979 May;19(5):319–323. doi: 10.1097/00005373-197905000-00003. [DOI] [PubMed] [Google Scholar]
- Flint L. M., Mays E. T., Aaron W. S., Fulton R. L., Polk H. C. Selectivity in the management of hepatic trauma. Ann Surg. 1977 Jun;185(6):613–618. doi: 10.1097/00000658-197706000-00001. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Gartman D. M., Zeman R. K., Cahow C. E., Baker C. C. The value of hepatobiliary scanning in complex liver trauma. J Trauma. 1985 Sep;25(9):887–891. doi: 10.1097/00005373-198509000-00012. [DOI] [PubMed] [Google Scholar]
- Gillmore D., McSwain N. E., Jr, Browder I. W. Hepatic trauma: to drain or not to drain? J Trauma. 1987 Aug;27(8):898–902. [PubMed] [Google Scholar]
- Hanna S. S., Gorman P. R., Harrison A. W., Taylor G., Miller H. A., Pagliarello G. Blunt liver trauma at Sunnybrook Medical Centre. J Trauma. 1987 Sep;27(9):965–969. doi: 10.1097/00005373-198709000-00001. [DOI] [PubMed] [Google Scholar]
- Hau T., Hoffman R., Simmons R. L. Mechanisms of the adjuvant effect of hemoglobin in experimental peritonitis. I. In vivo inhibition of peritoneal leukocytosis. Surgery. 1978 Feb;83(2):223–229. [PubMed] [Google Scholar]
- Ishitani M. B., McGahren E. D., Sibley D. A., Spotnitz W. D., Rodgers B. M. Laparoscopically applied fibrin glue in experimental liver trauma. J Pediatr Surg. 1989 Sep;24(9):867–871. doi: 10.1016/s0022-3468(89)80584-6. [DOI] [PubMed] [Google Scholar]
- Ivatury R. R., Nallathambi M., Gunduz Y., Constable R., Rohman M., Stahl W. M. Liver packing for uncontrolled hemorrhage: a reappraisal. J Trauma. 1986 Aug;26(8):744–753. doi: 10.1097/00005373-198608000-00011. [DOI] [PubMed] [Google Scholar]
- Kram H. B., Reuben B. I., Fleming A. W., Shoemaker W. C. Use of fibrin glue in hepatic trauma. J Trauma. 1988 Aug;28(8):1195–1201. doi: 10.1097/00005373-198808000-00010. [DOI] [PubMed] [Google Scholar]
- Kudsk K. A., Sheldon G. F., Lim R. C., Jr Atrial-caval shunting (ACS) after trauma. J Trauma. 1982 Feb;22(2):81–85. doi: 10.1097/00005373-198202000-00001. [DOI] [PubMed] [Google Scholar]
- Levin A., Gover P., Nance F. C. Surgical restraint in the management of hepatic injury: a review of Charity Hospital Experience. J Trauma. 1978 Jun;18(6):399–404. doi: 10.1097/00005373-197806000-00004. [DOI] [PubMed] [Google Scholar]
- MADDING G. F. Injuries of the liver. AMA Arch Surg. 1955 May;70(5):748–756. doi: 10.1001/archsurg.1955.01270110120017. [DOI] [PubMed] [Google Scholar]
- Mays E. T. Lobar dearterialization for exsanguinating wounds of the liver. J Trauma. 1972 May;12(5):397–407. doi: 10.1097/00005373-197205000-00011. [DOI] [PubMed] [Google Scholar]
- McInnis W. D., Richardson J. D., Aust J. B. Hepatic trauma: pitfalls in management. Arch Surg. 1977 Feb;112(2):157–161. doi: 10.1001/archsurg.1977.01370020051005. [DOI] [PubMed] [Google Scholar]
- Moore E. E., Shackford S. R., Pachter H. L., McAninch J. W., Browner B. D., Champion H. R., Flint L. M., Gennarelli T. A., Malangoni M. A., Ramenofsky M. L. Organ injury scaling: spleen, liver, and kidney. J Trauma. 1989 Dec;29(12):1664–1666. [PubMed] [Google Scholar]
- Mullins R. J., Stone H. H., Dunlop W. E., Strom P. R. Hepatic trauma: evaluation of routine drainage. South Med J. 1985 Mar;78(3):259–261. [PubMed] [Google Scholar]
- Noyes L. D., Doyle D. J., McSwain N. E., Jr Septic complications associated with the use of peritoneal drains in liver trauma. J Trauma. 1988 Mar;28(3):337–346. doi: 10.1097/00005373-198803000-00009. [DOI] [PubMed] [Google Scholar]
- Pringle J. H. V. Notes on the Arrest of Hepatic Hemorrhage Due to Trauma. Ann Surg. 1908 Oct;48(4):541–549. doi: 10.1097/00000658-190810000-00005. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Rivkind A. I., Siegel J. H., Dunham C. M. Patterns of organ injury in blunt hepatic trauma and their significance for management and outcome. J Trauma. 1989 Oct;29(10):1398–1415. doi: 10.1097/00005373-198910000-00019. [DOI] [PubMed] [Google Scholar]
- Schrock T., Blaisdell F. W., Mathewson C., Jr Management of blunt trauma to the liver and hepatic veins. Arch Surg. 1968 May;96(5):698–704. doi: 10.1001/archsurg.1968.01330230006002. [DOI] [PubMed] [Google Scholar]
- Scott C. M., Grasberger R. C., Heeran T. F., Williams L. F., Hirsch E. F. Intraabdominal sepsis after hepatic trauma. Am J Surg. 1988 Feb;155(2):284–288. doi: 10.1016/s0002-9610(88)80715-3. [DOI] [PubMed] [Google Scholar]
- Stone H. H., Lamb J. M. Use of pedicled omentum as an autogenous pack for control of hemorrhage in major injuries of the liver. Surg Gynecol Obstet. 1975 Jul;141(1):92–94. [PubMed] [Google Scholar]
- Svoboda J. A., Peter E. T., Dang C. V., Parks S. N., Ellyson J. H. Severe liver trauma in the face of coagulopathy. A case for temporary packing and early reexploration. Am J Surg. 1982 Dec;144(6):717–721. doi: 10.1016/0002-9610(82)90557-8. [DOI] [PubMed] [Google Scholar]
- Walt A. J. Founder's lecture: The mythology of hepatic trauma--or Babel revisited. Am J Surg. 1978 Jan;135(1):12–18. doi: 10.1016/0002-9610(78)90003-x. [DOI] [PubMed] [Google Scholar]
- Waymack J. P., Rapien J., Garnett D., Tweddell J. S., Alexander J. W. Effect of transfusion on immune function in a traumatized animal model. Arch Surg. 1986 Jan;121(1):50–55. doi: 10.1001/archsurg.1986.01400010056007. [DOI] [PubMed] [Google Scholar]