Liver injuries- a tertiary rural medical college hospital experience

Abstract

Background: Liver is the most frequently injured solid intra abdominal organ in abdominal trauma. Exsanguination is the main cause of death due to liver trauma. Although non-operative management of hepatic trauma has been utilized with increasing frequency a significant percentage of unstable liver trauma still require operative treatment. The aim of the present study was to examine the results of the operative treatment of patients with unstable liver trauma and prevent prolonged hospital stay. Patients admitted following Liver Trauma in the department of General Surgery, MOSC medical college Hospital, Kolenchery duringthe two year period from January 2013 to January 2015 were included in the study. Methods: This was a retrospective study of patients with Hepatic trauma admitted to the department of General Surgery, MOSC Medical College Hospital, Kolenchery, Ernakulam from January 2013 to January 2015. The diagnosis of Liver trauma was made pre-operatively with imageology and assessed clinically prior to surgery. Severity of liver injury was graded, treatment details collected and factors contribution to prolonged hospital stay were noted. These patients were later followed up for a period of one year. Results: During the two year period, 105 patients who were diagnosed to have liver injury were included in the study. Age varied from 1275 years. Males outnumbered females (88.5% vs. 11. 43 %). 93 patients were with blunt abdominal trauma (88.5%). 66(62.85%) patients were in shock when they presented to the ER. 36 (37.15%) patients were haemodynamically stable. 57 patients (54.28%) had associated injuries like multiple rib fractures and splenic injuries. Exploratory laparotomy and control of bleeding, hepatorapphy and local debridement was done. Nine patientsrequired relaparotomy and omental packing. Fifteen patients succumbed to liver injury. The postoperative period was delayed in those patients who had other visceral injury. Follow up of cases for a period of 1 year was done and there was no late complication like intra-abdominal abscess, coagulopathy, bile leak or hepatic abscess. Conclusion: Emergency laparotomy with hemostasis and repair liver injury in unstable cases and select stable cases savestime and life of the patient, it is cost effective and hospital stay and systemic complications are minimal