Wounds of the Liver in Vietnam

Carroll, Charles; Cass, Kenneth A.; Whelan, Thomas J.

doi:10.1097/00000658-197304000-00001

Cited by 19 publications

(3 citation statements)

References 16 publications

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“…This is no longer the procedure of choice and is only employed in about 10% of patients [1,2]. In war the severity of injuries leading to fragmentation of the liver leaves no alternative but resection in a similar 10% of cases [4,18]. In recent years perihepatic packing has gained ground in civilian practice.…”

Section: Livermentioning

confidence: 99%

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Abdominal trauma in war

Rignault

1992

World j. surg.

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In war, the percentage of casualties with abdominal wounds on battlefields is near 20%. Roughly half of these casualties die almost immediately from bleeding. Wounding agents are most often either bullets or fragments from various detonating devices. Severity of pathology induced by these agents and prolonged lag time between injury and treatment constitute major differences between peace and war abdominal injuries. Since the means of diagnosis is unsophisticated in war, penetrating abdominal injury leads to systematic exploratory laparotomy, although 10% to 20% of explorations are negative. The management of colon lesions remains a controversial issue. In modern war surgery manuals, primary colon repair is not totally condemned and is generally considered acceptable, but under stricter criteria than in civilian practice. In abdominal war wounds, mortality rate dropped from 53% during World War I to 18-36% at the end of World War II. In Vietnam it went down near 10% in some limited hospital series. But other data collected during that conflict show a less rosy picture. Of 476 abdominal casualties, the total mortality reached 42%. The hospital mortality among the survivors was 11.5%. Death in cases where abdominal wound was the primary lesion was due to hemorrhage in 60%, sepsis in 25%, and pulmonary insufficiency in 15%. Survivors had an average of 1.8 injured organs.

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Section: Livermentioning

confidence: 99%

“…War series from Vietnam [18] show that in addition to coagulation disorders, biliary fistulas are the main complication of liver trauma. This emphasizes the need for adequate drainage of the perihepatic area.…”

Section: Livermentioning

confidence: 99%

Abdominal trauma in war

Rignault

1992

World j. surg.

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“…Indeed, in a recent series of 270 patients treated by Walt' only 5 with stab wounds died; the complication rate, largely the result of wound infection and pulmonary atelectasis, was 1200. The mortality for gunshot wounds is higher, at about 12%, though that in American casualties in Vietnam, mainly from high-velocity missile wounds, was somewhat less.5 6 The mortality from blunt liver injury has shown the most dramatic decrease-from 60°/,7 8 to 30%/o or less.' 9-11 Even for the most severe injuries, requiring hepatic resection, mortality is now less than 40h 1'12 and most deaths occur in association with severe damage to the head or chest.…”

Section: Liver Injurymentioning

confidence: 99%