Inferior vena caval injury in the firearm era.

BACKGROUND

This study compared the outcome of intra-abdominal caval injuries in the current era of firearm injuries with the outcome during the previous era of stab wounds.

METHODS

Patients with intra-abdominal vena caval injuries treated at King Edward VIII Hospital, Durban, from December 1990 to December 1995 were reviewed. This group was compared with a similar cohort reviewed a decade earlier.

RESULTS

The historical group consisted of 28 patients and the current group of 26 patients. Modes of injury in the historical group were: stabs (15, 53%), firearm injuries (7, 33%), blunt trauma (4, 14%) and iatrogenic injuries (2, 7%). Modes of injury in the current group were: stabs (5, 19%), firearm injuries (17, 65%) and blunt trauma (4, 16%). Mortality rose from 35.7% in the historical group to 88% in the current series. This mortality figure included 5 patients who died later from complications of the associated injuries.

CONCLUSIONS

Firearm injuries are more destructive than stab wounds. The increase in firearm injuries partly explains this higher mortality. However, the failure to apply current concepts of abbreviated laparotomy and damage control combined with excessive delays in transferring patients to theatre have contributed to this high mortality.