The problems and characteristics of hepatic war trauma management in central Dalmatia during the 1991-1995 war in Croatia.

OBJECTIVE

War injuries to the liver treated during the 1991-1995 war in central Dalmatia, Croatia, were analyzed retrospectively.

METHODS

There were 713 patients with abdominal injuries, 125 (17%) of whom were operated on for liver injuries. Mobile surgical teams operated on 91 patients (73%) in rear war hospitals (echelons II and III); only 34 patients (27%) were immediately transferred to and operated on at the Split University Hospital.

RESULTS

After wounds to the small and large intestine, liver injuries were the third most common abdominal injuries. Morbidity was 63%, and reoperations were required in 20% of cases. Fourteen patients (11%) died. The highest rate of complications was observed in patients with postoperative inflammatory intra-abdominal collection, disseminated intravascular coagulation, adult respiratory distress syndrome, sepsis, or ileus. The highest mortality was found in those patients requiring a right hemihepatectomy.

CONCLUSIONS

The best results were achieved in patients on whom, after hepatotomy, selective hemostasis with liver debridement was carried out.