Management of penetrating hepatic injury. A review of 102 consecutive patients.

The records of 102 consecutively treated patients with penetrating hepatic injuries from 1972 through 1982 were reviewed. Fifty-five patients (54%) sustained gunshot wounds and 47 (46%) sustained knife wounds. The mean age was 29 years (range 3-71); 83 per cent were men. Hypovolemic shock was present in 39 per cent of all the patients, and 74 patients (73%) required perioperative transfusions. Major associated injuries were present in 65 patients (64%) with 30 patients having two or more other injuries. All patients received preoperative and postoperative antibiotics and 88 per cent were treated with intraabdominal drains. Fifteen patients were managed with a tamponade technique using multiple Penrose drains within the injury tract. Six patients (5.9%) required hepatic resection. Major vascular injuries were present in ten cases, and seven of these patients survived. Hospital stay ranged from 4 to 60 days with a mean of 14 days. Postoperative complications occurred in 42 per cent of the patients with over one-third of the complications being pulmonary related. Mortality was 2.9 per cent and all three deaths were secondary to bleeding from severe liver and associated vascular injuries. The low incidence of hepatic resection and mortality in this series of patients is attributed to the conservative management of liver injuries, adequate drainage, the use of a tamponade technique with multiple Penrose drains for through-and-through liver injuries and the expeditious repair of the vascular injuries. This paper includes a detailed description of the tamponade technique.