Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress
Clinical Collections
Advances in Alzheimer’s

At a glance: The STEP trials

A round-up of the STEP phase 3 clinical trials evaluating semaglutide for weight loss in people with overweight or obesity.
ADVANCED SEARCH
Log in
Top
European Journal of Trauma and Emergency Surgery
Published in: European Journal of Trauma and Emergency Surgery 2/2016

01-04-2016 | Original Article

The role of computed tomography in determining delayed intervention for gunshot wounds through the liver

Authors: G. Sachwani-Daswani, A. Dombrowski, P. C. Shetty, J. A. Carr

Published in: European Journal of Trauma and Emergency Surgery | Issue 2/2016

Login to get access

Abstract

Introduction

Gunshot wounds through the liver are highly lethal and are prone to delayed morbidity due to late complications.

Methods

A retrospective study was performed to determine the incidence, morbidity, and need for late interventions in patients shot through the liver, and the role of post-injury CT in making those determinations.

Results

83 patients were shot through the liver. Injury grades were: Grade V—12 (14 %), Grade IV—41 (49 %), Grade III—12 (14 %), Grade II—8 (10 %), Grade I—1 (1 %), and nine were ungraded. Ten (12 %) died in the ED, three (4 %) died in the OR, and two (2 %) died postoperatively. Of the 68 survivors, 52 (76 %) had follow-up CT scans performed a median of 7 days (95 % CI 2–13 days) after injury. Seventeen (33 %) had 25 complications related to the bullet tract: 12 (48 %) abscesses, 6 (24 %) infected hematomas, 3 (12 %) bilomas, 3 (12 %) unclassified fluid collections, and 1 (4 %) hepatic necrosis. Treatment included CT-guided drainage in 15 (60 %), ultrasound-guided drainage in 3 (12 %), surgical drainage and debridement in 2 (8 %), and observation in 5 (20 %). Overall morbidity rate including hepatic and non-hepatic complications was 74 % (50/68). Patients having their CT scan-determined intervention (for all complications) within 7 days of injury (n = 24), compared to those having their CT scan-determined intervention on day 8 or later (n = 28), had a significantly decreased rate of overall complications and morbidity (p = 0.03). This difference was due to early detection and intervention for abscesses, anastomotic breakdown, and missed injuries. Those having a CT scan within 7 days of injury also had a significantly reduced length of stay compared to those scanned on day 8 or later (median 14 days, 95 % CI 4–24 days versus 18 days, 95 % CI 6–30 days, p = 0.05).

Conclusions

Gunshot wounds to the liver have a high morbidity and mortality rate. Survivors should have a follow-up CT scan performed within 7 days to allow detection and intervention for complications, as this dramatically decreases the overall morbidity rate and length of stay.
Literature
1.
Marr JD, Krige JE, Terblanche J. Analysis of 153 gunshot wounds of the liver. Br J Surg. 2000;87(8):1030–4.CrossRefPubMed
2.
Schnuriger B, Talving P, Barbarino R, Barmparas G, Inaba K, Demetriades D. Current practice and the role of the CT in the management of penetrating liver injuries at a level I trauma center. J Emerg Trauma Shock. 2011;4(1):53–7.CrossRefPubMedPubMedCentral
3.
Krige JE, Bornman PC, Terblanche J. Liver trauma in 446 patients. S Afr J Surg. 1997;35(1):10–5.PubMed
4.
5.
Demetriades D, Karaiskakis M, Alo K, Velmahos G, Murray J, Asensio J. Role of postoperative computed tomography in patients with severe liver injury. Br J Surg. 2003;90(11):1398–400.CrossRefPubMed
6.
Knudson MM, Lim RC, Olcott EW. Morbidity and mortality following major penetrating liver injuries. Arch Surg. 1994;129(3):256–61.CrossRefPubMed
7.
Asensio JA, Demetriades D, Chahwan S, Gomez H, Hanpeter D, Velmahos G, Murray J, Shoemaker W, Berne TV. Approach to the management of complex hepatic injuries. J Trauma. 2000;48(1):66–9.CrossRefPubMed
8.
Asensio JA, Roldan G, Petrone P, Rojo E, Tillou A, Kuncir E, Demetriades D, Velmahos G, Murray J, Shoemaker WC, et al. Operative management and outcomes in 103 AAST-OIS grades IV and V complex hepatic injuries: trauma surgeons still need to operate, but angioembolization helps. J Trauma. 2003;54(4):647–53 (discussion 53–4).CrossRefPubMed
9.
Sclafani SJ, Shaftan GW, McAuley J, Nayaranaswamy T, Mitchell WG, Gordon DH, Glanz S. Interventional radiology in the management of hepatic trauma. J Trauma. 1984;24(3):256–62.CrossRefPubMed
10.
Cogbill TH, Moore EE, Jurkovich GJ, Feliciano DV, Morris JA, Mucha P. Severe hepatic trauma: a multi-center experience with 1335 liver injuries. J Trauma. 1988;28(10):1433–8.CrossRefPubMed
11.
Dabbs DN, Stein DM, Scalea TM. Major hepatic necrosis: a common complication after angioembolization for treatment of high grade liver injuries. J Trauma. 2009;66:621–7.CrossRefPubMed
12.
Lawson CM, Daley BJ, Ormsby CB, Enderson B. Missed injuries in the era of the trauma scan. J Trauma. 2011;70:452–6.CrossRefPubMed
13.
Fabian TC, Croce MA, Stanford GG, Payne LW, Mangiante EC, Voeller GR, Kudsk KA. Factors affecting morbidity following hepatic trauma. A prospective analysis of 482 injuries. Ann Surg. 1991;213(6):540–7 (discussion 8).CrossRefPubMedPubMedCentral
14.
Chopra SS, Haacke N, Meisel C, Unterwalder N, Fikatas P, Schmidt SC. Postoperative immunosuppression after open and laparoscopic liver resection: assessment of cellular immune function and monocytic HLA-DR expression. J Society Laparoendo Surg (JSLS). 2013;17:615–21.CrossRef
15.
Kunkle DA, Kansas BT, Pathakk A, Goldberg AJ, Mydlo JH. Delayed diagnosis of traumatic ureteral injuries. J Urol. 2006;176:2503–7.CrossRefPubMed
Metadata
Title
The role of computed tomography in determining delayed intervention for gunshot wounds through the liver
Authors
G. Sachwani-Daswani
A. Dombrowski
P. C. Shetty
J. A. Carr
Publication date
01-04-2016
Publisher
Springer Berlin Heidelberg
Published in
European Journal of Trauma and Emergency Surgery / Issue 2/2016
Print ISSN: 1863-9933
Electronic ISSN: 1863-9941
DOI
https://doi.org/10.1007/s00068-015-0523-y

Other articles of this Issue 2/2016

European Journal of Trauma and Emergency Surgery 2/2016 Go to the issue

Original Article

Symphyseal internal rod fixation versus standard plate fixation for open book pelvic ring injuries: a biomechanical study

Original Article

Infectious complications and mortality in an American acute care surgical service

Editorial

Advancing clinician-performed sonography in the twenty-first century: building on the rich legacy of the twentieth century pioneers

Original Article

Tailored ultrasound learning for acute care surgeons: a review of the MUSEC (Modular UltraSound ESTES Course) project

Original Article

Secondary abdominal compartment syndrome after complicated traumatic lower extremity vascular injuries

Original Article

Hyperbilirubinaemia in appendicitis: the diagnostic value for prediction of appendicitis and appendiceal perforation