Penetrating liver war injury: a report on 172 cases

During the 4-year military conflict in Croatia, we treated operatively 7,928 casualties. Of those casualties, 172 (2.2%) had penetrating liver injury, mostly sustained by explosive devices. Of these injuries, 90.7% were associated with the trauma of other abdominal and extra-abdominal organs. Seventy-five percent of injuries belonged to grades III and IV on the Liver Injury Scale. The main method of treatment was debridement with ligation of severed vessels and bile ducts. In 8.1% of cases with detrimental bleeding, we used liver packing. Fifty percent of these patients have survived but with a high incidence of septic complications. This method was proven salutary in the most detrimental injuries that could not be treated in any other way. Postoperative hemorrhage and intra-abdominal abscesses were complications that needed surgical and ultrasound-guided aspiration, respectively. Numerous heavy injuries of the liver combined with associated trauma of other vital organs are responsible for the high mortality rate of 28.5%.