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Civilian low velocity gunshot wounds of the liver
A K Leppäniemi1, J A Salo, R K Haapiainen
1Second Department of Surgery, Helsinki University Central Hospital, Finland.
Objective:
To report our experience in the management of hepatic gunshot wounds.
Design:
Retrospective study of medical records.
Setting:
University department of surgery, Finland.
Subjects:
38 patients admitted with hepatic gunshot wounds confirmed at operation.
Interventions:
Laparotomy in all cases.
Main Outcome Measures:
Morbidity and mortality.
Results:
Of the 35 low velocity bullet wounds of the liver, 23 (66%) were severe, but 34 (97%) could be managed with simple operative techniques. Two of the three shotgun injuries were at point-blank range, and one required lobectomy. Four patients (11%) died, and in all cases haemorrhage from associated cardiovascular injuries was a major contributing factor. Postoperative morbidity after bullet wounds was 57%, including two local hepatic complications.
Conclusions:
Simple operative repairs are sufficient and safe in most patients with low velocity bullet wounds of the liver. Associated injuries are the main cause of postoperative mortality and morbidity. Point-blank shotgun injuries involving the liver are not necessarily fatal.