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Gunshot wound versus blunt liver injuries: different liver-related complications and outcomes



Severe hepatic injury due to gunshot (GSW) compared to blunt mechanism may have significantly different presentation, management, complications, and outcomes. The aim of this study was to identify the differences.


Retrospective single-center analysis June 1, 2015–June 30, 2020, included all patients with Grade III–V liver injuries due to GSW or blunt mechanism. Clinical characteristics, severity of injury, liver-related complications (rebleeding, necrosis/abscess, bile leak/biloma, pseudoaneurysm, acute liver failure) and overall outcomes (mortality, hospital length of stay, intensive care unit length of stay, and ventilatory days) were compared.


Of 879 patients admitted with hepatic trauma, 347 sustained high-grade injury and were included: 81 (23.3%) due to GSW and 266 (76.7%) due to blunt force. A significantly larger proportion of patients with GSW were managed operatively (82.7 vs. 36.1%, p < 0.001). GSW was associated with significantly more liver-related complications (40.7% vs. 27.4%, p = 0.023), specifically liver necrosis/abscess (18.5% vs. 7.1%, p = 0.003) and bile leak/biloma (12.3% vs. 5.3%, p = 0.028). On subgroup analysis, in patients with grade III injury, the incidence of liver necrosis/abscess and bile leak/biloma remained significantly higher after GSW (13.9% vs. 3.1%, p = 0.008 and 11.1% vs. 2.5%, p = 0.018, respectively). In sub analysis of 88 patients with leading severe liver injuries, GSW had a significantly longer hospital length of stay, ICU length of stay, and ventilator days.


GSW mechanism to the liver is associated with a higher incidence of liver–related complications than blunt force injury.

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Correspondence to Meghan R. Lewis.

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Yong Fu, Meghan Lewis, Delbrynth Mitchao, Elizabeth Benjamin, and Monica Wong declare that they have no conflict of interest. Demetrios Demetriades is an editorial board member of the European Journal of Trauma and Emergency Surgery.

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This study has been approved by the appropriate ethics committee (University of Southern California Institutional Review Board) and has therefore been performed in accordance with the ethical standards laid down in the 1964 Declaration of Helsinki and its later amendments.

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Fu, Y., Lewis, M.R., Mitchao, D.P. et al. Gunshot wound versus blunt liver injuries: different liver-related complications and outcomes. Eur J Trauma Emerg Surg (2022).

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  • Liver injury
  • Trauma
  • Liver-related complications