Abdominal trauma with special reference to hepatic trauma.

Of 882 patients admitted over a 6-year period to the adult trauma service at the Health Sciences Centre in Winnipeg, 325 (37%) suffered from abdominal trauma; 241 (74%) sustained a blunt injury and 84 (26%) a penetrating wound. Laparotomy is indicated when there is evidence of intra-abdominal hemorrhage, perforation of a viscus or penetration of the peritoneum. Peritoneal lavage is extremely useful in the diagnosis of intra-abdominal bleeding; it was used in 79 cases among which were four false-positive and two false-negative results. Fifty-six cases of hepatic injury were treated; 43 of these were caused by blunt trauma. Temporary packing and drainage sufficed as treatment in many of these patients but the placing of suture-ligatures at exposed bleeding points is often called for. Resection of hepatic tissue was required in 10 cases and ligation of the right hepatic artery in 2. Of the seven deaths in the series only one was attributed to the liver injury itself.