GUNSHOT INJURIES OF THE LIVER - THE BARAGWANATH EXPERIENCE

Background. This study comprised 304 patients with gunshot injuries of the liver, many of which from high-velocity firearms. The purpose of this study is to evaluate our management policy in gunshot injuries of the liver in light of our recent wider experience. Methods. All grade I and II injuries and most grade III injuries were managed by simple operative measures, without postoperative mortality directly related t o the liver trauma. Results. Grade III, IV, and V injuries had 8.5%, 5 2%, and 16% resectional debridement rates and 8.5%, 38%, and 84% perih epatic packing rates, respectively. In the resectional debridement gro up the postoperative mortality rate was 15% (half the deaths were dire ctly caused by the hepatic injury). The postoperative mortality rate i n the perihepatic packing group was 31.5% of which 45% of deaths were due to ongoing bleeding, 27.5% to sepsis, and 27.5% to associated trau ma. The septic complications were less common when packs were removed early.Conclusions. We suggest that resectional debridement and perihep atic packing should be liberally applied in the most severe grade III, most grade IV, and grade V gunshot injuries of the liver and that per ihepatic packing should be removed as early as the physiologic derange ments are corrected. Our experience with grade VI injuries is very lim ited, and their management should be studied in larger series.