PATTERN AND MANAGEMENT OF HEPATIC INJURIES IN NORTH WEST OF PAKISTAN

Forty consective patients with liver injuries were studied in a period of fourteen months i.e. 1st June 1997 to 31st July 1998. Majority of the patients were young male adults with mean age of 30 years (range 16-17 years). Male of female ratio was 9:1. Thirty three patients (82.5%) had penetrating injuries and 7 had substained blunt trauma. Twenty five (62.5%) patients were in a state of shock at the time of arrival, in emergency department, with stock index > 1. Injury severity score was 29.1. All patients had to be explored surgically in casualty operation theatre. Right lobe was injured in 67.5% while left in 30% of cases. Twenty seven patients (67.5%) had other associated injuries (other organs in addition to liver). Average number of organs injured per patient was 2.75. Twenty seven patients (67.5%) had sustained simple liver injuries and were managed by simple technique of hepatic repair. Thirteen patients (32.5%) had complex liver injuries and had to have more complex surgical procedure Le. extensive hepatorrhaphy, resection/ debridement and selective hepatic artery ligation). Post operative complications were wound infection, wound dehiscence, post operative bleeding form liver, intra-abdominal sepsis, biliary leak and jaundice. Five patients died (mortality 12.5%). Mortality was high in patients with complex liver injuries, advance age in those with blunt trauma.