Chervenkov, P.

Glinkov, S.

Madjov, R.

English

Varna Medical University Press: Journals

Script a Scientifica Medica, vol.28, Suppl.l,pp.13-14 Copyright ©Medical University, Varna, 1991 LIVER I N J U R Y P. Chervenkov, S . Glinkov, R. Madjov Department of Surgery, Varna The marked tendency of increasing of road-accidents and indus-trial injuries led to extension of liver injuries, according to literature -12,1 to 32 ,4%, in cases of abdominal and thoracoabdominal trauma. Improved knowledge of medicine, earlier and more competent re-suscitation and anaesthesia, improved intensive care of the severely in-jured patient have contributed to the remarkable decline in the mortality associated with liver trauma - today - 5% for penetrating injury and 10% for blunt one (1,2,3,5). In addition, accurate assessment of the extent of liver trauma has allowed for more appropriate surgical approach. Liver can be injured in cases of blunt and penetrating abdominal and thoracoabdominal trauma and for our country blunt injuries prevail over penetrating - 81-90%. Liver is the second most commonly injured organ, fol lowing blunt trauma (in our series -15,92%) after spleen in-jury. There are lots of classif ications of liver injuries: according to the mechanism, cl inical features etc. One of the most convenient and suit-able for everyday practice is the classif ication of W. Schweizer, L. H. Blumgart, A. Huber (Univ. of Bern) - five grades according to the se-verity of the injury (2). For the time period 1985-1991 (VI m.) 157 patients with abdomi-nal and thoracoabdominal trauma were hospitalized in our Cl inic - 114 males (79,7%) and 43 females (27,3%), at the age from 16 to 73 years. Of them, 29 were with penetrating injury (18,47%) and 128 - with blunt one (81,53%). 87 (55,4%) patients were with abdominal trauma, 47 ones (29,93%) -with thoracoabdominal, and 23 (14,65%) - with multi-plex concomitant injuries. Liver injury was found in 25 patients (15,92%); males -17 (68%) , females - 8 (32%). Up to the 2 n d hour from the onset of the trauma were hospitalized 3 patients, up to 6 t h hour - 8 patients, up to 1 2 t h hour - 1 3 patients and up to 2 4 t h hour one patient. According to the severity of liver injury the distribution of our patients w a s : I gr. - 3 pts, It gr. - 8 pts, III gr. - 10 pts, IV gr. -3 pts and V gr. - 1 patient. The most import-ant signs in the initial cl inical examination were: acute haemorrhage (in severe cases up to shock) - found in 12 of our patients; tenderness in the right upper abdomen and lower thorax, and sometimes shoulder pain, ranging from weak to violent pain. It is more probably a sign of the trauma itself, rather than a pathognomonic sign of liver injury; nau 14 sea, vomiting and flatulence - late symptoms. Blood pressure at the beginning can be unaffected, but in the next hours, clinical examin-ation reveals a rising pulse and falling blood pressure, i. e. change of shock index, though in many cases, frank signs of shock may be delayed for some hours. Since the mortality increases with delay in diagnosis and treatment, any investigations must be undertaken ur-gently. With very high diagnostic accuracy are laparoscopy (per-formed in 14 cases) and abdominocentesis (in 7 ones). According to circumstances, but only in patients after resuscitation, we can use non-invasive diagnostic methods - ultrasonography and C.T. In cases of questionable and problematic patients, marked hypovole-my, very poor condition of patients we can make diagnostic explora-tive laparotomy. The choice of operative management depends on the severity and extent of liver injury. We've performed the following operative procedures: suture -19 ; suture + packing -3; right hemihepatectomy - 1; suture of iiver and V. portae - 1 ; partial resection - 1 . Bleeding from the liver can be control-led by packing and by Pringle's manoeuvre - in cases of III and IV gr. liver injury. Postoperative mortality in our patients is 12,5% (3 patients): two of them with severe concomitant injuries and one patient with ruptu-ra-conquasatio of liver and lesion of v. v. hepaticae. In 4 patients we have done intraoperative autohemotransfusion - the volume of rein-fused blood ranged from 250 to 750 ml. In conclusion, in order to optimize the results from the manage-ment of liver injuries we attach great importance to: - early and accurate diagnosis of liver injury with usage of abdomi-nocentesis and Laparoscope - early operative management and adequate resuscitation of trau-ma patients; - application of intraoperative autohemotransfusion; - early and precise diagnosis and treatment of the complications from liver injury. References: 1. Vasilev N., P.Kazandjiev. Liver injuries, 1989,213-225. -2. Schweizer W., A.Huber, L.BIumgart. Surgery, 1988,1471-1476. -3. Moore E.E. Ann. Surg., 148,1984,712-716. -4. Najarian J . S . , J.P.Delaney. Emergency Surgery, 1982. -5. Calne R.Y., F.C.Welles, J . Foty. Br. J . Surg. 69,1982,365-368. 

LIVER INJURY

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LIVER INJURY

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Varna Medical University Press: Journals