The Operative Management for Gunshot Liver Injuries: an Experience of Seventy-One Patients in 5 Years

Abstract

Abdominal gunshot wounds have become a major problem globally, and it is commonly associated with liver injury. The aim of this study is to review our experience and outcomes of operative management of gunshot liver injures. A case series analysis reviewed all patients who underwent emergency laparotomy following liver gunshot injuries from January 1, 2011, to December 31, 2016. The collected data included age, gender, vital signs on admission, blood transfusion, grade of liver injury, associated intra-abdominal injuries, surgical procedures performed and re-operations, morbidity, and mortality rate. During the study period, we have done 71 operations for gunshot liver injured patients. The mean age was 28.5 years. There were 68 men and three women. There were 56 patients who had multi-organ injuries, while 64 patients were in shock. Liver injury grade I was occurred in two patients, while grades II, III, IV, and V have occurred in 10, 34, 19, and 6 patients, respectively. Liver tissue hemostasis was done in seven patients, 25 underwent liver tissue primary repair, 15 had direct blood vessel ligation, 21 were treated with perihepatic packing as part of damage control surgery, and three patients had a non-anatomical liver resection. Postoperative liver-related complications occurred in 15 patients, bleeding occurred in nine patients, the biliary leak in five, and hepatic abscess with septicemia in one patient. Despite the acceptance of selective non-operative management like hepatic angioembolization with its high success rate, expeditious exploratory laparotomy still has an effective role in the treatment of gunshot wounds of the liver with advanced grade penetrating injuries with acceptable morbidity and mortality.