Hepatic trauma: an Indian experience

Over a five year period, between January 1989 and December 1993, a total of 230 patients with confirmed hepatic injuries were treated at a major urban trauma center. The mechanism of injury was blunt in 154 patients (67%). Nonoperative treatment was given in 18 patients (8%). All operated patients were explored through a midline incision. A "T" extension over the right hypochondrium was required in 24 patients (10%), while a right thoracotomy extension was needed in 16 patients (7%). Simple hepatorrhaphy, use of topical hemostatic agents or peritoneal drainage alone were performed in 151 (66%) patients. Extensive hepatorrhaphy, hepatotomy with selective vascular ligation, resection with debridement or resection alone, perihepatic packing and major vascular ligation were undertaken, often in combination in 61 (26%) patients. Percutaneous arterial embolization was carried out in one patient. The mortality rate was 19%. The most frequent postoperative complications related to hepatic injury were intraabdominal abscesses (6%) and coagulapathy (5%). Prolonged biliary leak (3%), late hemorrhage (1%) and hepatic necrosis (1%) were also observed.