ABSTRACT
Background : Liver injury is a challenging intraabdominal injury with a high morbidity and mortality rate. We describe details of this interesting injury that was treated at Siriraj Hospital. Objective : To review mechanism of injury, severity of injury, treatment and mortality rate of liver injury at Siriraj Hospital. Methods : A retrospective study of liver injuries that occurred during May 1997 and March 2000 was done. Analysis of the data was made be a simple statistical method using mean and percentage. Results : Sixty-eight patients with liver injury who were admitted of and had completely recorded data from Siriraj Hospital were analyzed, including 56 males and 12 females. Mean age was 28.6 yr. (4.60). Regarding mechanism of injury,39 (57.4%) were affected from blunt ingury,26 (38.2%) were had stab wounds, and 3 (4.4%) had gunshot wounds. Fifty-five patents with liver injury (80.9%) had at least one site of other organ injury (77 sites in 55 patents). The most common other injury was chest in injury (28 sites including 13 sites of diaphragmatic injury) This study included 23 (33.8%), 24 (35.3%), 18 (26.5%), 1 (1.5%) and2 (2.9%) patients who were classified as grade I, II, III, IV and V of liver injury respectively. Surgery was performed in 66 patients whereas only 2 patients were observed and CT scanning for successful nonoperative management. Cauterizaton and suture of injured liver were the two most common procedures that were performed in our hospital, 52.9% and 23.5% of cases respective, had they were limited to only grade I, II and III liver injury. The overall mortality rate was 11.8%, with only 8.5% being grade I and II but markedly increased to 19% in grades III, IV and V. Conclusion : More than half of the liver injuries in this study were from blunt injury, the other 42.6% were from penetrating injury. There was a high rate of associated injury. Most hepatic injuries were minor (69.2%) In this study surgery was per formed in 66 patients whereas only 2 patients were observed. Nonoperative management was not widely used, In case of an operation, one or more surgical procedures were used, including electrocautery, suturing of liver parenchyma or vessels, packing of the liver ligating the hepatic artery and repairing the vena cava. In complex hepatic injury, we prefer the conventional method by perihepatic packing. The overall mortality rate was 11.8%
ABSTRACT
To study the measurement of intra-abdominal pressure by urinary catheter, we use Y glass tube connected with Foley catheter. The bladder and catheter was filled with 70 ml. NSS. The height of NSS from pubic symphysis was interpreted as intra-abdominal pressure (IAP). We measured IAP of 20 trauma patients with normal abdominal condition. The average IAP was 3.9 cm H2O. The clinical consequences of elevated IAP will be in the future study.
ABSTRACT
Eighty five patients with splenic injury, 72 males and 13 females, 2-18 years of age, from the Department of Surgery, Siriraj Hospital, were managed by standard surgical procedure with an attempt to preserve the spleen. There were only 20 cases (23.53%) in which the splenic salvage succeeded, others had too much contraindication for splenic salvage. In the 20 cases, one had non-bleeding capsular tear, 14 underwent splenorrhaphy, 4 underwent partial splenectomy and splenic artery ligation was performed in one case. During a period of 2 years and 5 months, the success rate of the splenic salvage increased progressively from 10% in the first year to 33.3% in the last 5 months. In 65 cases of the splenectomy, 6 cases underwent splenic reimplantation without postoperative complication. Recently, the more conservative procedure is often performed instead of the splenectomy in all patients with splenic injury. Even one who undergoes splenectomy, splenic reimplantation also plays an alternative method in restoring normal protective function against the overwhelming post-splenectomy infection in selected case.