HEMOSTATIC METHODS FOR THE MANAGEMENT OF SPLEEN AND LIVER INJURIES

The spleen and liver are the most frequently injured organs during blu nt and penetrating abdominal trauma. Emergency laparotomy is crucial f or early control of bleeding and to prevent ''secondary'' injury as a result of physiologic splanchnic vasoconstriction and free oxygen radi cals. Altogether 98 patients with spleen and liver injuries were treat ed over an 8-year period. Primary orthotopic spleen preservation could be achieved in 46 of 63 patients. In 58 patients with hepatic trauma, hemostatic treatment was chosen based on the severity of the injury. Nonoperative management was used for four splenic and seven hepatic tr auma patients. The most commonly used techniques were fibrin sealing, suturing, and debridement for hepatic injury and mesh splenorrhaphy, f ibrin glue, and partial resection with a TA stapler for splenic injury . The death of patients with complex injuries was mainly due to precli nical massive blood loss and multiple organ failure.