Keywords : penetrating injury


Management of Liver Injury; An Experience from Baghdad Teaching Hospital

Tariq Al-aubaidi; Ahmed Mohammed; Mohannad kamel Al Bermani

Iraqi Postgraduate Medical Journal, 2017, Volume 16, Issue 3, Pages 290-297

ABSTRACT:
BACKGROUND:
The liver is the second most commonly injured organ in abdominal trauma, liver injury could be caused by trauma to abdomen, lower chest and back (blunt or penetrating injury) and may be associated with high mortality and morbidity depending on the mechanism of injury and associated injuries.
OBJECTIVE:
Discuss the types and grades of liver injury, assess treatment modalities and identify morbidity and mortality caused by liver injury.
PATIENTS AND METHODS:
This is a prospective study; included 60 patients admitted with liver injury within period of 13 months from (1st.January 2015- 31 st. January 2016) in Baghdad Teaching Hospital, Only patients who underwent operative management were included in this study. They were analyzed according to their age, gender, and mechanism of injury, site of trauma, physical examination, investigations, and details of management which include operative management.
RESULTS:
In this study, most injured patients were male 54 (90%) patients and 6 (10%) patients were female. The peak incidence of age was in those between 20-29 years, 28 (46.67%) patients while the lowest incidence was in those between 50-60 years, 2 (3.33%) patients. 52 (86.67%) patients had penetrating liver injury making it the most common type of injury and 8(13.33%) patients had blunt liver injury. The patients in this study were diagnosed by clinical examination, imaging study and exploratory laparotomy.
23 (38.33%) patients had grade II liver injury making it the most commonly encountered grade of injury while 19 (31.67%) patients had grade III as second most common grade of injury. Diaphragmatic injury was the most common associated organ injury with liver injury 30 (50%) patients. Surgical options for treatment of liver injury depend on general condition of the patients and grade of liver injury; simple suturing (hepatorrhaphy) with gelfoam was the most commonly used modality of treatment. Regarding postoperative complications, wound infection was the most common postoperative complication 8 (13.33%) patients followed by respiratory complications in 6 (10%) patients, jaundice in 5 (8.33%) patients, bile leak in 3 (5%) patients ,subphrenic collection in 3 (5%) patients ,disseminated intravascular coagulopathy (DIC) had occurred in 3 (5%) patients, bleeding occurred in 2 (3.33%) patients, hemobilia occurred in 1 (1.67%) patient and liver abscess and necrosis occurred in 1 (1.67%) patient .
CONCLUSION:
The most common grades of liver injury were grade II and grade III. The mortality rate increases with increasing the evidence of vascular injury.

Penetrating Carotid Artery Injuries

Abdul Salam Y Taha

Iraqi Postgraduate Medical Journal, 2013, Volume 12, Issue 1, Pages 96-103

ABSTRACT:
BACKGROUND:
Penetrating carotid artery injuries (PCAI) in civil time are infrequent, yet they present significant diagnostic and therapeutic challenges and can be associated with significant morbidity and mortality. Proper resuscitation and urgent exploration is necessary for actively bleeding patients.
OBJECTIVE:
The aim of this paper is to present our humble experience in management of such injuries with literature review.
PATIENTS AND METHODS:
Herein, we present 5 cases of penetrating carotid artery injuries managed in Sulaimania and Basrah from January 1996 to 30th of November 2009.
RESULTS:
All patients were young males. Three injuries were located in zone III and 2 in zone II. Four patients presented hours to days after the injury while the fifth presented after few months. Angiography was done in 2 patients with a false aneurysm of internal carotid artery (ICA). All 3 patients with ICA injuries were managed by ligation due to profuse bleeding and poor access. The 2 patients with common carotid artery (CCA) injuries in zone II had an end to end repair. All 5 patients have survived without significant neurological deficits.
CONCLUSION:
Penetrating carotid artery injuries in zone II usually do not require preoperative angiography unlike those in zone I and III. Repair is always desired. It is a straightforward operation for zone II injuries but really challenging for zone III due to poor access. Certain zone III injuries may be just observed or treated by endovascular stenting when facilities permit. Ligation of ICA carries a high risk of stroke; however, young people with well developed circle of Willis may tolerate it well