Over a 10-year period, a series of 34 patients with the hepatobiliary injury are analyzed, and a few
literature are reviewed.
1. The high incidence is seen in the first and second decades. The ratio of man to woman is 4.7
to 1. (Table 1)
2. Main cause of the penetrating type injury is stab wound. (63.2%), and tha of the non-penetrating
type injury is traffic accident (66.7%) (Table 2).
3. Right lobe of the liver is mainly involved in 55.8%, and the left lobe in 17.6%, Gallbladder is
involved in 4 cases only (Table 3).
4. Abdominal pain is complained in 94.1% of this series. 44.1% of this series is in shock or pre
shock state at the time of admission (Table 4).
5. Laboratory examinations such as hemoglobin level or leucocytosis are not significant in this series.
Abdominal tappings are done in 11 cases, and show positive finding such as blood or bile juice in every
case. Therefore abdominal tapping is strongly recommended in patient suspecting injury on the hepato
biliary system.
6. Time elapsed between injury and operation is relatively short in penetrating group comparing
with that of non-penetrating group (Table 5).
7. Associated injury is found in 68.4% of penetrating group, and in 93.3% of non-penetrating group.
33 organs are involved in penetrating group, and 26 organs in non-penetrating group. (Table 6).
8. Mean amount of the whole blood transfusion is 3.6 pints in penetrating group, and 7.1 pints in
non-penetrating group.
9. Surgical techniques employed in this series are primary suture with Cat-gut, debridement, resection
of the fragment, and adequate drainage procedure. Hepatic lobectomy is done in sevreal cases. T-tube
choledochotomy is done in the recent 4 cases with good results.
10. Complications are found in 35.3% with predominances of infection, and bile leakage. Spontaneous
healing of the bile leakage is expected.
11. Mortality rate is 11.4%. Mortality rate excluding the galbladder injury is 12.9%. Main cause
of the death is the massive bleeding (75%). Deaths are observed in non-penetrating group only.
|