ABSTRACT
The mortality of grade V and VI liver trauma fluctuates between 30percent and 70percent. The atriocaval shunt, described by Shrock et al, in 1968, is a therapeutic option that, after being installed, allows to repair the suprahepatic veins and retrohepatic cava in a bloodless surgical field. Its use requires an experienced and skilled surgeon to obtain survival rates similar to those obtained with other methods. We report two male patients of 17 and 18 years old treated successfully with this technique after suffering a blunt and a penetrating liver trauma by a shotgun, respectively.
Subject(s)
Adolescent , Male , Humans , Arteriovenous Shunt, Surgical/methods , Venae Cavae/surgery , Venae Cavae/injuries , Hepatic Veins/surgery , Hepatic Veins/injuries , Liver/injuries , Vena Cava, Inferior/surgery , Vena Cava, Inferior/injuries , Vena Cava, Superior/surgery , Vena Cava, Superior/injuriesSubject(s)
Humans , Female , Contraceptives, Oral, Combined , Liver , Liver/physiopathology , Liver/injuries , Liver/metabolism , Hormones/metabolism , Liver Diseases , Adenoma, Liver Cell , Budd-Chiari Syndrome , Carcinoma, Hepatocellular , Cholecystitis , Cholestasis , Cholestasis, Intrahepatic/physiopathology , Focal Nodular Hyperplasia , Hyperbilirubinemia, Hereditary , Jaundice, Chronic Idiopathic , Liver Neoplasms , Peliosis Hepatis , Porphyrias, Hepatic , Risk Factors , Hepatic Veins/injuriesABSTRACT
Sobre una serie de 376 heridos de bala en abdomen se analizan 101 lesiones hepáticas. Se procede a clasificar las mismas y evaluar las distintas posibilidades terapéuticas. Se pone énfasis en posturas menos agresivas hemostasia directa, a la revalorización del packing evitando suturas en masa con puntos amplios y/o resecciones anatómicas innecesarias. Realizamos una comparación entre la Clasificación de Moore, el factor de riesgo hallado (lesión asociada) y la causa de muerte. La magnitud de la lesión hepática no guarda estricta relación con la mortalidad puesto que, en este tipo de traumatismo las lesiones concomitantes juegan un rol fundamental. La asociación de acidosis, coagulopatía e hipotermia contribuyen a elevar los índices de morbimortalidad.