Gunshot injuries to the liver

The role of selective nonoperative management

Demetrios Demetriades, Hugo Gomez, Santiago Chahwan, Kyriakos Charalambides, George Velmahos, James Murray, Juan A. Asensio, Thomas V. Berne

Research output: Contribution to journalArticle

71 Citations (Scopus)

Abstract

Background: Selective nonoperative management of blunt liver injuries has become standard practice in most trauma centers. We evaluated the role of selective nonoperative management of gunshot wounds to the liver. Study Design: This was a retrospective review of gunshot wounds to the liver treated in a level I trauma center. Patients with peritoneal signs or hemodynamic instability were operated on without delay. Patients with a soft, nontender abdomen and no signs of heavy bleeding were selected for nonoperative management. Liver injury was diagnosed by CT scan. If peritonitis or signs of substantial internal bleeding developed, an operation was performed; otherwise the patient was discharged within a few days of admission. Analysis was restricted to the group of patients with isolated liver injuries. Results: During a 42-month period, 928 patients were admitted with abdominal gunshot injuries, 152 of whom (16%) had a liver injury. In 52 patients (34% of all liver injuries), the liver was the only injured intraabdominal organ (4 patients had associated kidney or splenic injuries that did not require surgical repair). Thirty-six of the patients (69%) with isolated liver injuries had an emergent operation because of signs of peritonitis or hemodynamic instability. The remaining 16 patients (31%) were selected for nonoperative management (3 patients had associated right kidney injury). Five patients in the observed group required delayed operation because of development of signs of peritonitis (4 patients) or abdominal compartment syndrome (1 patient). The remaining 11 patients (7% of all liver injuries or 21% of isolated liver injuries) were managed successfully without operation. One patient with delayed operation developed multiple complications from abdominal compartment syndrome, and 1 patient in the nonoperative group had a biloma, which was treated with percutaneous drainage. Conclusions: Selected patients with isolated grades I and II gunshot wounds to the liver can be managed nonoperatively.

Original languageEnglish
Pages (from-to)343-348
Number of pages6
JournalJournal of the American College of Surgeons
Volume188
Issue number4
DOIs
StatePublished - 1999
Externally publishedYes

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Liver
Wounds and Injuries
Gunshot Wounds
Peritonitis
Intra-Abdominal Hypertension
Trauma Centers
Hemodynamics
Hemorrhage
Kidney
Abdominal Injuries
Nonpenetrating Wounds
Abdomen
Drainage

All Science Journal Classification (ASJC) codes

  • Surgery

Cite this

Demetriades, D., Gomez, H., Chahwan, S., Charalambides, K., Velmahos, G., Murray, J., ... Berne, T. V. (1999). Gunshot injuries to the liver: The role of selective nonoperative management. Journal of the American College of Surgeons, 188(4), 343-348. https://doi.org/10.1016/S1072-7515(98)00315-9

Gunshot injuries to the liver : The role of selective nonoperative management. / Demetriades, Demetrios; Gomez, Hugo; Chahwan, Santiago; Charalambides, Kyriakos; Velmahos, George; Murray, James; Asensio, Juan A.; Berne, Thomas V.

In: Journal of the American College of Surgeons, Vol. 188, No. 4, 1999, p. 343-348.

Research output: Contribution to journalArticle

Demetriades, D, Gomez, H, Chahwan, S, Charalambides, K, Velmahos, G, Murray, J, Asensio, JA & Berne, TV 1999, 'Gunshot injuries to the liver: The role of selective nonoperative management', Journal of the American College of Surgeons, vol. 188, no. 4, pp. 343-348. https://doi.org/10.1016/S1072-7515(98)00315-9
Demetriades, Demetrios ; Gomez, Hugo ; Chahwan, Santiago ; Charalambides, Kyriakos ; Velmahos, George ; Murray, James ; Asensio, Juan A. ; Berne, Thomas V. / Gunshot injuries to the liver : The role of selective nonoperative management. In: Journal of the American College of Surgeons. 1999 ; Vol. 188, No. 4. pp. 343-348.
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abstract = "Background: Selective nonoperative management of blunt liver injuries has become standard practice in most trauma centers. We evaluated the role of selective nonoperative management of gunshot wounds to the liver. Study Design: This was a retrospective review of gunshot wounds to the liver treated in a level I trauma center. Patients with peritoneal signs or hemodynamic instability were operated on without delay. Patients with a soft, nontender abdomen and no signs of heavy bleeding were selected for nonoperative management. Liver injury was diagnosed by CT scan. If peritonitis or signs of substantial internal bleeding developed, an operation was performed; otherwise the patient was discharged within a few days of admission. Analysis was restricted to the group of patients with isolated liver injuries. Results: During a 42-month period, 928 patients were admitted with abdominal gunshot injuries, 152 of whom (16{\%}) had a liver injury. In 52 patients (34{\%} of all liver injuries), the liver was the only injured intraabdominal organ (4 patients had associated kidney or splenic injuries that did not require surgical repair). Thirty-six of the patients (69{\%}) with isolated liver injuries had an emergent operation because of signs of peritonitis or hemodynamic instability. The remaining 16 patients (31{\%}) were selected for nonoperative management (3 patients had associated right kidney injury). Five patients in the observed group required delayed operation because of development of signs of peritonitis (4 patients) or abdominal compartment syndrome (1 patient). The remaining 11 patients (7{\%} of all liver injuries or 21{\%} of isolated liver injuries) were managed successfully without operation. One patient with delayed operation developed multiple complications from abdominal compartment syndrome, and 1 patient in the nonoperative group had a biloma, which was treated with percutaneous drainage. Conclusions: Selected patients with isolated grades I and II gunshot wounds to the liver can be managed nonoperatively.",
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AU - Asensio, Juan A.

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