Liver injuries in northern ireland

Hepatic resection

“…Five of the 8 patients in this series were below the age of 30. This high incidence of liver injuries in the younger agegroup is in keeping with the findings of other authors (Hellstrom, 1961;Mills, 1961;Hanna, Bell, and Cochran, 1965).…”

“…Often the viability of the tissues is in doubt, and the lacerated portion may be attached to the liver by only a small segment. I n the past such injuries were treated by packing, which had a high mortality and morbidity rate (Hellstrom, 1961 ;Hanna, 1965). Packing with gauze packs often failed to control the bleeding, and further fatal haemorrhage often recurred after removal of packs (Jaffe, 1956).…”

“…In recent years there has been a definite decline in the use of gauze packs (Sparkman and Fogelman, 1954;Crosthwait and others, 1962) and an increasing tendency to resort to hepatic resection in severe blunt injuries of the liver (Picard, 1960;Byrd and McAfee, 1961;Smith, 1964;Hanna, Bell, and Cochran, 1965;Longmire, 1966).…”

Right hemihepatectomy for severe blunt injury

“…So there appear to be simple and sound reasons for anticipating better results when badly injured liver is resected : reliable and direct control of haemorrhage, clean dkbridement of all unhealthy or devitalized tissue, adequate drainage of bile, serums,and infection, and generally avoiding the disadvantages of packing. Melnikov (1956) appears to have been the first to Technique.-The technique described here worked well, but better descriptions have been given elsewhere (Lortat-Jacob and Robert, 1952;Lloyd-Davies and Angell, 1957;Quatelbaum and Quatelbaum, 1959;Smith, 1961 ;Brunschwig, 1965;Hanna, 1965).…”

“…A sixth danger arises from leaving necrotic or hypoxic liver tissue in situ. Not only is this a potential site for serious infection (Fine, 1955), but it can cause other harm: there is neat experimental evidence to show that the presence of ischaemic liver seriously reduces the ability of dogs to survive the effects of any subsequent haemorrhage (Atik, Isla, Grossman, and de Kernian, 1966 Brunschwig, 1965;Hanna, 1965).…”