The problems and characteristics of hepatic war trauma management in central Dalmatia during the 1991-1995 war in Croatia

Abstract

Objective: War injuries to the liver treated during the 19911995 war in central Dalmatia, Croatia, were analyzed retrospectively. Methods: There were 713 patients with abdominal injuries, 125 (17%) of whom were operated on for liver injuries. Mobile surgical teams operated on 91 patients (73%) in rear war hospitals (echelons II and III); only 34 patients (27%) were immediately transferred to and operated on at the Split University Hospital. Results: After wounds to the small and large intestine, liver injuries were the third most common abdominal injuries. Morbidity was 63%, and reoperations were required in 20% of cases. Fourteen patients (11%) died. The highest rate of complications was observed in patients with postoperative inflammatory intra- abdominal collection, disseminated intravascular coagulation, adult respiratory distress syndrome, sepsis, or ileus. The highest mortality was found in those patients requiring a right hemihepatectomy. Conclusions: The best results were achieved in patients on whom, after hepatotomy, selective hemostasis with liver debridement was carried out.