Inferior vena caval injury in the firearm era

Background. This study compared the outcome of intra-abdominal caval injuri es in the current era of firearm injuries with the outcome during the previ ous era of stab wounds. Methods. Patients with intra-abdominal vena caval injuries treated at King Edward VIII Hospital, Durban, from December 1990 to December 1995 were revi ewed. This group was compared with a similar cohort reviewed a decade earli er. Results. The historical group consisted of 28 patients and the current grou p of 26 patients. Modes of injury in the historical group were: stabs (15, 53%), firearm injuries (7, 33%), blunt trauma (4, 14%) and iatrogenic injur ies (2, 7%). Modes of injury in the current group were: stabs (5, 19%), fir earm injuries (17, 65%) and blunt trauma (4, 16%). Mortality rose from 35.7 % in the historical group to 88% in the current series. This mortality figu re included 5 patients who died later from complications of the associated injuries. Conclusions. Firearm injuries are more destructive than stab wounds. The in crease in firearm injuries partly explains this higher mortality. However, the failure to apply current concepts of abbreviated laparotomy and damage control combined with excessive delays in transferring patients to theatre have contributed to this high mortality.