Management of liver trauma in Kuwait

The aim of this study was to introduce the concept of non-operative management [NOM] for blunt liver trauma by establishing a protocol and a prospective Liver Trauma Registry in Kuwait. A prospective Liver Trauma Registry was started in 4 hospitals and it included 117 patients who had sustained blunt liver trauma [94 men and 23 women]. Unstable patients were taken to surgery while stable patients were managed conservatively regardless of the grade of liver injury. High-grade [III-VI] liver injuries were managed in collaboration with the liver surgery specialist. The mean age of the 117 patients was 29.02 +/- 11.18 years [range 7-63]. NOM was successful in 94 [96%] patients and failed in 4 [4%] [these 4 then underwent successful surgery]. Nineteen [16.2%] were unstable and underwent surgery immediately; 15 [79%] of them survived [they had had grade III-V injuries] and 4 died [2 with grade V injuries and 2 with grade VI injuries]. Perihepatic packing was necessary in 8/19 [42%] patients. The overall mortality was 3.4% [4/117]. This study showed that NOM was successful in a majority of patients with blunt liver trauma. In addition, it confirmed that the magnitude of liver injury and haemoperitoneum did not preclude NOM as long as the patient was haemodynamically stable

Surgical treatment of thoracic and lumbar tuberculosis by anterior interbody fusion and posterior instrumentation

To evaluate the efficacy and clinical outcome of simultaneous or sequential anterior and posterior surgical approaches in the management of spinal tuberculosis in the form of anterior extirpation of the tuberculous lesion, strut bone grafting of the defect produced and posterior instrumentation for spinal fixation. Subjects and Twenty-two patients who had tuberculosis of the thoracic and lumbar spine with moderate to severe localized kyphosis and variable degrees of neurological deficits were treated at Al Razi Hospital [Kuwait] in the period from 1998 to 2000 by anterior debridement and autogenous strut bone grafting with simultaneous or staged posterior spinal fixation using either USS or SOCON spinal instrumentation. Appropriate antituberculosis treatment was given to all patients for 9-12 months. The postoperative follow-up period was 18 months. Of the 22 cases the average of preoperative kyphosis was 42°. The average of immediate postoperative correction was 27°. At the last follow-up the average correction was 24° and the loss of correction did not exceed 3°. Average fusion times were 5 months for one-segment fusions and 8 months for two-segment fusions. There was no recurrence of the disease in any of the cases. Posterior instrumental stabilization and anterior interbody fusion were found to be effective in arresting the disease, correcting kyphotic deformity and maintaining correction until solid spinal fusion

Ruptured hepatoma: report of 5 cases in Arabs

Objective and Importance: Ruptured hepatic tumours are common among South East Asians. They are rare in whites and in Arabs. Arab cirrhotics who develop acute abdominal pain associated with hypovolaemia and evidence of intra-abdominal bleeding ought to be suspected of ruptured hepatocellular carcinoma. Clinical Presentation: Five cases of ruptured hepatocellular carcinoma in Arabs are reported. All patients had liver cirrhosis, and radical surgery was not possible due to the advanced stage of the tumour. Two patients who underwent common hepatic artery ligation survived for more than 9 months after the acute episode. The other 3 died in the hospital due to liver failure. Hepatic dearterialization was found effective in controlling bleeding from ruptured hepatoma. Other modalities of management such as hepatic artery embolization or intratumoural alcohol injection have been found effective in controlling bleeding