PECULIARITIES OF SEVERE LIVER GUNSHOT WOUNDS PATHOMORPHOSIS

Authors:

Abstract:

The purpose of the study was to determine the pathomorphological peculiarities of liver gunshot wounds. The study material was liver slices after gunshot shrapnel wounds to the colon (12 studies) from 1 hour to 6 days after the injury. Histological preparations were taken during primary surgical interventions after gunshot wounds of the liver and during repeated interventions. The most common were superficial cracks and subcapsular hemorrhages of various shapes and sizes, which had a variety of colours from light red to dark blue and were located mainly on the anterior part of the diaphragmatic surface and the anterior parts of the visceral surface of the liver. In case of liver ruptures, violations of the integrity of the liver parenchyma to different depths with the formation of a slit-like cavity were determined. The tissue crushing had different degrees of depth and volume - from superficial, with damage to small subcapsular layers of the parenchyma, to deep, with the transformation of entire liver lobes into a shapeless mass, consisting of crushed cells, partially interconnected by remnants of connective tissue. The authors concluded that liver injuries pathomorphological examination shows the following types of injuries: capsule cracks and subcapsular hemorrhages, liver parenchymal ruptures, crushing, hematomas. In traumatic necrosis of the liver parenchyma, the stromal component in the form of portal tracts remains preserved for the first few days. At the edges of hematomas, on the first day after the injury, perifocal areas of necrosis of the liver parenchyma appear, which are caused by the compressive factor of the hematoma itself. In wounds lasting more than 2 days, the zone of necrosis progresses around the hematomas due to ischemic infarctions, which can be explained by thrombus formation in the vessels and the phenomena of hypovolemic shock.

Keywords:

gunshot wounds liver pathomorphosis pathogenetic mechanisms surgical tactics treatment rehabilitation

References:

1. Atlas boyovoyi khirurhichnoyi travmy (dosvid antyterorystychnoyi operatsiyi/operatsiyi obyednanykh syl). Pid. red. V.I. Tsimbalyuk. Kharkiv: Collegium, 2021. 385 [in Ukrainian].
2. Horalskyy LP, Khomych VT, Kononskyy OI. Osnovy histolohichnoyi tekhniky i morfofunktsionalni metody doslidzhen u normi ta pry patolohiyi. Zhytomyr : ZhNAEU, 2019: 286 [in Ukrainian].
3. Medychna dopomoha uchasnykam boyovykh diy. Pid. red. O.M. Khvysyuk, V.H. Marchenko, B.V. Mykhaylov. Kharkiv: DISA Plyus, 2019. 576 [in Ukrainian].
4. Nastanovy z voyenno-polovoyi khirurhiyi. Pid. red. K.V. Humenyuk, S.O. Korol, R.V. Hybalo. Kyyiv: Vydavnytstvo Lyudmyla, 2024. 572 [in Ukrainian].
5. Patomorfoz vohnepalnykh ran myakykh tkanyn. Pid. red. V.I. Tsimbalyuk. Kharkiv: Collegium, 2018. 176 [in Ukrainian].
6. Khomenko IP, Gerasimenko OS, Yenin RV, Galushka AM, Kazmirchuk AP. Osoblyvosti khirurhichnoho likuvannya vohnepalnykh poranen zhyvota. Klinichna khirurhiia. 2018; 85(9): 71-74. doi: 10.26779/2522-1396.2018.09.71 [in Ukrainian].
7. Khomenko IP, Kochyna ML, Shipilov SA. Doslidzhennya struktury zvyazkiv morfofunktsionalnykh pokaznykiv postrazhdalykh z vohnepalnymy poranennyamy diafrahmy z vykorystannyam faktornoho analizu. Ukrayinskyy zhurnal medytsyny, biolohiyi ta sportu. 2019; 4(5): 230-237. doi: 10.26693/jmbs04.05.230 [in Ukrainian].
8. Eze UO, Ojifinni KA. Trauma Forensics in Blunt and Sharp Force Injuries. J West Afr Coll Surg. 2022; 12(4): 94-101. doi: 10.4103/jwas.jwas_190_22.
9. Giorgetti A, Giraudo C, Viero A, Bisceglia M, Lupi A, Fais P. et al. Radiological investigation of gunshot wounds: a systematic review of published evidence. Int J Legal Med. 2019; 133(4): 1149-1158. doi: 10.1007/s00414-019-02071-8.
10. Heninger M. Concordance Rate for the Identification of Distant Entrance Gunshot Wounds of the Back by Experienced Forensic Pathologists Examining Only Images of Autopsies. J Forensic Sci. 2016; 61(2): 352-360. doi: 10.1111/1556-4029.13011.
11. Lurin I, Vorovskiy O, Makarov V, Khoroshun E, Nehoduiko V, Ryzhenko A. et al. Management of thoracoabdominal gunshot injuries by using minimally invasive surgery at role 2 deployed field hospitals in Ukraine. BMC Surgery. 2024; 24:183. doi: 10.1186/s12893-024-02475-3.
12. Matoso RI, Freire AR, Santos LSM, Junior ED, Rossi AC, Prado FB. Comparison of Gunshot Entrance Morphologies Caused by 40-Caliber Smith & Wesson, 380-Caliber, and 9-mm Luger Bullets: A Finite Element Analysis Study. PLoS One. 2014; 9(10): 111192. doi: 10.1371/journal.pone.0111192.
13. Morell-Hofert D, Primavesi F, Fodor M, Gassner E, Kranebitter V, Braunwarth E. et al. Validation of the revised 2018 AAST-OIS classification and the CT severity index for prediction of operative management and survival in patients with blunt spleen and liver injuries. Eur Radiol. 2020; 30(12): 6570-6581. doi: 10.1007/s00330-020-07061-8.
14. O'Neill SB, Hamid S, Nicolaou S, Qamar SR. Changes in Approach to Solid Organ Injury: What the Radiologist Needs to Know. Can Assoc Radiol J. 2020; 71(3): 352-361. doi: 10.1177/0846537120908069.
15. Thoma V, Franchetti G, Geisenberger D, Glardon M, Kromeier J, Mierdel K. et al. Gunshot wounds in parenchymatous organs: the morphology mainly depends on the physical properties of the affected tissues. Int J Legal Med. 2023; 137(5): 1463-1469. doi: 10.1007/s00414-023-03058-2.

Publication:

«World of Medicine and Biology» Vol. 21 No. 92 (2025) , с. 197-201
УДК 616.12:616.24

DOI:

https://doi.org/10.26724/2079-8334-2025-2-92-197-201