Injuries of the Liver

Madding, Gordon F.

doi:10.1001/archsurg.1955.01270110120017

Cited by 69 publications

(13 citation statements)

References 16 publications

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“…The liverrelated mortality rate dropped to only 28% after World War II, due to an increased experience with primary repair of liver injuries. This led to an avoidance of packing [19]. At that time, packing was associated with a high incidence of late sepsis, rebleeding with pack removal, and neglected penetrating wounds [19].…”

Section: Discussionmentioning

confidence: 99%

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The Efficacy of Gauze Packing in Liver Trauma: an Evaluation of the Management and Treatment of Liver Trauma

Estourgie¹,

Werken²,

Leenen

2002

European Journal of Trauma

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Background: This study evaluates the management and treatment of liver trauma with emphasis on the efficacy of gauze packing. Material and Methods: 92 patients, diagnosed with liver trauma between 01/1992 and 01/2000, were evaluated retrospectively. For clinical management reasons, a distinction was made between hemodynamically stable and unstable patients. Results: 42 patients were clinically diagnosed as hemodynamically stable and had an average Injury Severity Score (ISS) of 24. 15 of them underwent abdominal surgery. In ten of these patients additional liver treatment was performed. The mortality among the 42 patients was two, both non-liver-related (sepsis and neurologic injury). 50 patients were considered to be hemodynamically unstable and had an average ISS of 35. All patients needed abdominal surgery. The mortality was 22 out of 50, of which seven were liver-related.In 38 of all 92 patients only gauze packing was used as initial therapy. In twelve patients the bleeding was controlled by the first tamponade, and ten patients needed a second tamponade after an average of 2 days. Additional surgery was performed in nine patients, and seven patients died shortly after the first laparotomy. The mortality was 16, of which nine were directly liverrelated. Conclusion: Gauze packing as the initial treatment of liver trauma is considered a safe and quick method for controlling ongoing hemorrhage. Nevertheless, severe liver trauma goes with a high mortality rate.

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Section: Discussionmentioning

confidence: 99%

“…This led to an avoidance of packing [19]. At that time, packing was associated with a high incidence of late sepsis, rebleeding with pack removal, and neglected penetrating wounds [19]. Since the late 70s, packing has regained its popularity, being reported as life-saving in highly selected patients [2,20].…”

Section: Discussionmentioning

confidence: 99%

The Efficacy of Gauze Packing in Liver Trauma: an Evaluation of the Management and Treatment of Liver Trauma

Estourgie¹,

Werken²,

Leenen

2002

European Journal of Trauma

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“…In only a few cases is violent haemorrhage from the liver a primary emergency, as in most cases the bleeding stops before the operation takes 'place (Madding, 1955). Before the second world war the mortality of non-penetrating injuries of the liver was particularly high, and death was frequently due to infection, often causing secondary haemorrhage.…”

Section: Commentmentioning

confidence: 99%

Rupture of the Liver in an Epileptic

Peeling¹

1966

BMJ

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Injury during epileptic fits commonly involves the extremities or the head but rarely causes dangerous intra-abdominal injury. This case report presents the diagnostic problem of such a patient. CASE REPORTA man aged 59 was admitted in a collapsed state after four epileptic fits, which had occurred during the previous few hours. He had suffered from epilepsy for 15 years, which had been well controlled by phenobarbitone and epanutin.On admission he was semiconscious, pale, sweating, dyspnoeic, and slightly cyanosed; the radial pulse was not palpable and his blood-pressure was 110/60 mm. Hg. He was able to say that he had pain in the back (D8-L2 region), and denied pain in the. abdomen or the chest; no other information was forthcoming.When examined there was no tenderness of the spine or back and no bruising of the overlying skin. In the abdomen there was efght tenderness of the right hypochondrium but no other significant signs, and again no bruising of the skin 'of the abdominal wall or the chest. Radiographs excluded fracture of the ribs or the vertebrae, and there was no evidence that the patient had suffered a cardiac infarction or a vascular disaster to account for his profound state of collapse.The initial diagnosis was acute pancreatitis, and intravenous therapy with gastric aspiration was started. During this time the level of the patient's serum amylase had been estimated and was normal, and, as the patient had improved steadily with blood transfusion, the possibility of intraperitoneal bleeding was considered but thought unlikely as he was then fully rational and had no pain in the abdomen, back, or shoulders. Six hours after admission he suddenly developed pain in the left hypochondrium with tenderness, rebound, and rigidity, and, as the abdomen had become silent since admission, haemoperitoneum due to rupture of the spleen was diagnosed and laparotomy was arranged at once.The operation was begun through a midline epigattric incision and the peritoneal cavity contained over 3 pints (1.7 litres) of blood. The spleen was intact. However, blood clots were seen overlying the right lobe of the liver, and a transverse extension of the incision made through the abdominal wall in that direction exposed a transverse rent in the upper surface of the liver measuring 3 in. (7.6 cm.) in length and ending in a large subcapsular haematoma. This had been the site of the bleedings but at the time of the operation haemorrhage was minimal and stopped as soon as the torn margins had been apposed with two deep catgut sutures tied over a thin strip of Surgicel. No other intra-abdominal injury was present, and the abdomen was closed with drainage of the right subdiaphragmatic space.The patient made a slow recovery after operation. He had two more epileptic fits during the first 12 hours, and a brisk haemorrhage from the liver on the third post-operative day required the transfusion of two bottles of blood. After this, drainage from the peritoneal cavity diminished and had dried up by the fourteenth day. The abdominal wound...

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“…1 It must be tight or it is of no use: if too tight it will produce pressure necrosis and favour secondary haemorrhage. 2 It tends to dam any flow of bile and is a potential source of infection leading to localized pockets of bile, abscesses, hepatitis, subphrenic infection, and increases the risk of chest complications (Madding, 1955).…”

Section: Causes Of Deathmentioning

confidence: 99%

The problems of closed liver injuries

Mills¹

1961

Gut

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From East Glamorgan Hospital, Church Village, Nr. Pontypridd SYNOPSIS Because laceration of the liver is a condition which the surgeon is rarely called upon to treat, 36 cases of liver injury admitted bAtween 1926 and 1958 have been reviewed and the results compared with those of other authors. As well as discussing the incidence of this injury and its relation to age, sex, and pathology, the surgical management is outlined. The greatest single factor which has assisted the surgeon is transfusion of whole blood. Early operation is considered advisable, and suturing is preferred in repairing damage to the liver substance and achieving haemostasis. Nevertheless, the mortality rate is high, in this series 60 %, which compares favourably with that of other series. It is notable that patients operated on have a better chance of survival than those not operated upon.

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Injuries of the Liver

Cited by 69 publications

References 16 publications

The Efficacy of Gauze Packing in Liver Trauma: an Evaluation of the Management and Treatment of Liver Trauma

The Efficacy of Gauze Packing in Liver Trauma: an Evaluation of the Management and Treatment of Liver Trauma

Rupture of the Liver in an Epileptic

The problems of closed liver injuries

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