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Zhu Z, Ye H, Zhang K, He G, Pan Z, Xian Y, Yang Y, Zhang C, Wu D. Naturally Derived Injectable Dual-Cross-Linked Adhesive Hydrogel for Acute Hemorrhage Control and Wound Healing. Biomacromolecules 2024; 25:2574-2586. [PMID: 38525818 DOI: 10.1021/acs.biomac.4c00105] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/26/2024]
Abstract
Developing biocompatible injectable hydrogels with high mechanical strength and rapid strong tissue adhesion for hemostatic sealing of uncontrolled bleeding remains a prevailing challenge. Herein, we engineer an injectable and photo-cross-linkable hydrogel based on naturally derived gelatin methacrylate (GelMA) and N-hydroxysuccinimide-modified poly(γ-glutamic acid) (γPGA-NHS). The chemically dual-cross-linked hydrogel rapidly forms after UV light irradiation and covalently bonds to the underlying tissue to provide robust adhesion. We demonstrate a significantly improved hemostatic efficacy of the hydrogel using various injury models in rats compared to the commercially available fibrin glue. Notably, the hydrogel can achieve hemostasis in porcine liver and spleen incision, and femoral artery puncture models. Moreover, the hydrogel is used for sutureless repair of the liver defect in a rat model with a significantly suppressed inflammatory response, enhanced angiogenesis, and superior healing efficacy compared to fibrin glue. Together, this study offers a promising bioadhesive for treating severe bleeding and facilitating wound repair.
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Affiliation(s)
- Ziran Zhu
- Beijing National Laboratory for Molecular Sciences, Institute of Chemistry, Chinese Academy of Sciences, No. 2 Zhongguancun North First Street, Haidian District, Beijing 100190, China
- Guangdong Provincial Key Laboratory of Advanced Biomaterials, Department of Biomedical Engineering, Southern University of Science and Technology, No. 1088 Xueyuan Avenue, Nanshan District, Shenzhen, Guangdong 518055, China
- University of Chinese Academy of Sciences, No.19(A) Yuquan Road, Shijingshan District, Beijing 100049, China
| | - Huijun Ye
- Guangdong Provincial Key Laboratory of Advanced Biomaterials, Department of Biomedical Engineering, Southern University of Science and Technology, No. 1088 Xueyuan Avenue, Nanshan District, Shenzhen, Guangdong 518055, China
| | - Kaiwen Zhang
- Guangdong Provincial Key Laboratory of Advanced Biomaterials, Department of Biomedical Engineering, Southern University of Science and Technology, No. 1088 Xueyuan Avenue, Nanshan District, Shenzhen, Guangdong 518055, China
| | - Gang He
- Guangdong Provincial Key Laboratory of Advanced Biomaterials, Department of Biomedical Engineering, Southern University of Science and Technology, No. 1088 Xueyuan Avenue, Nanshan District, Shenzhen, Guangdong 518055, China
| | - Zheng Pan
- Guangdong Provincial Key Laboratory of Advanced Biomaterials, Department of Biomedical Engineering, Southern University of Science and Technology, No. 1088 Xueyuan Avenue, Nanshan District, Shenzhen, Guangdong 518055, China
| | - Yiwen Xian
- Guangdong Provincial Key Laboratory of Advanced Biomaterials, Department of Biomedical Engineering, Southern University of Science and Technology, No. 1088 Xueyuan Avenue, Nanshan District, Shenzhen, Guangdong 518055, China
| | - Yu Yang
- Guangdong Provincial Key Laboratory of Advanced Biomaterials, Department of Biomedical Engineering, Southern University of Science and Technology, No. 1088 Xueyuan Avenue, Nanshan District, Shenzhen, Guangdong 518055, China
| | - Chong Zhang
- Guangdong Provincial Key Laboratory of Advanced Biomaterials, Department of Biomedical Engineering, Southern University of Science and Technology, No. 1088 Xueyuan Avenue, Nanshan District, Shenzhen, Guangdong 518055, China
| | - Decheng Wu
- Guangdong Provincial Key Laboratory of Advanced Biomaterials, Department of Biomedical Engineering, Southern University of Science and Technology, No. 1088 Xueyuan Avenue, Nanshan District, Shenzhen, Guangdong 518055, China
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2
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Gong SC, An S, Shin IS, Jung PY. Usefulness of Endoscopic Retrograde Cholangiopancreatography in the Diagnosis and Treatment of Traumatic Pancreatic Injury in Children. Diagnostics (Basel) 2023; 13:2044. [PMID: 37370939 DOI: 10.3390/diagnostics13122044] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2023] [Revised: 06/10/2023] [Accepted: 06/12/2023] [Indexed: 06/29/2023] Open
Abstract
Pediatric trauma patients are increasing, and trauma is the leading cause of death in children. Pancreatic injury is known as the fourth most common solid organ injury, but the diagnosis of pancreatic injury is often delayed due to the retroperitoneal location of the pancreas and the low sensitivity and specificity of diagnostic tests. Endoscopic retrograde cholangiopancreatography (ERCP) is an important test for the diagnosis and treatment of various biliary tract and pancreatic diseases. However, cases of performing ERCP in traumatic pancreatic injury in children have been rarely reported. Thus, we aimed to evaluate the usefulness of ERCP in traumatic pancreatic injury in children. Between January 1983 and December 2022, pediatric patients under the age of 18 who were treated for traumatic pancreatic injury at a single institution were recruited and retrospectively analyzed. Patient characteristics and clinical outcomes were assessed. Thirty-one patients were enrolled in this study. Among them, 15 (48.4%) patients underwent ERCP. The time to diet was significantly longer in the ERCP group. There were no statistically significant differences in other characteristics between the ERCP and the non-ERCP group. In nine (60%) patients of the ERCP group, ERCP was used for therapeutic intervention or as a decision-making tool for surgery, and was used to resolve pancreas-related complications. ERCP may be useful for the diagnosis and treatment of traumatic pancreatic injury in children. In addition, ERCP can be safely applied in children, and complications related to ERCP also may not increase. When obscure pancreatic injury is suspected, it is necessary to consider performing ERCP.
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Affiliation(s)
- Seong Chan Gong
- Department of Surgery, Yonsei University Wonju College of Medicine, Wonju 26426, Republic of Korea
| | - Sanghyun An
- Department of Surgery, Yonsei University Wonju College of Medicine, Wonju 26426, Republic of Korea
| | - In Sik Shin
- Department of Surgery, Yonsei University Wonju College of Medicine, Wonju 26426, Republic of Korea
| | - Pil Young Jung
- Department of Surgery, Yonsei University Wonju College of Medicine, Wonju 26426, Republic of Korea
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3
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Wahood W, Badar W, Funaki B, Leef JA, Ahmed O. Comparing Outcomes in Transcatheter Embolization for the Management of Penetrating versus Blunt Trauma. THE ARAB JOURNAL OF INTERVENTIONAL RADIOLOGY 2022. [DOI: 10.1055/s-0042-1758041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Abstract
Purpose This article assesses potential factors associated with successful embolization and/or mortality benefit among patients with penetrating (PT) compared to those with blunt abdominal trauma (BT) undergoing emergent angiography.
Methods A retrospective study of arterial embolization for BT and PT at a tertiary care academic center in an urban setting between 2018 and 2020 was conducted. Fischer's exact and Student's t-tests were used to assess differences between PT and BT, regarding technical success, in-hospital mortality, number of vessels embolized, and requirement of Operating Room (OR) for bleeding control after embolization.
Results Forty-three patients underwent embolization. Twenty-three presented with BT versus 20 with PT. There was no difference in the rate of success between the two groups (91.3% vs. 100%; p = 0.49). No difference was observed in mean days of survival among BT and PT patients treated by embolization (mean [standard deviation]: 13.7 [2.6] vs. 19.1 [2.79] days; p = 0.160). There was no difference in mortality between the two groups (13.0% vs. 10.5%; p = 1.00). Mean number of vessels embolized was higher in the BT group compared to PT (2.26 [1.32] vs. 1.44 [1.03], p = 0.044). The rate of BT patients who required subsequent OR intervention for hemorrhage control after embolization was similar to those with PT (8.7% vs. 10.5%; p = 0.84).
Conclusion The rate of mortality, technical success, and requirement of subsequent OR intervention for hemorrhage control was comparable between BT and PT. BT was associated with a higher mean number of vessels embolized compared to PT. Our case series may provide insight in the use of embolization for PT, but further investigation is needed with larger cohorts.
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Affiliation(s)
- Waseem Wahood
- Dr. Kiran C. Patel College of Allopathic Medicine, Nova Southeastern University, Davie, Florida, United States
| | - Wali Badar
- Section of Interventional Radiology, Department of Radiology, University of Illinois at Chicago, Chicago, Illinois, United States
| | - Brian Funaki
- Section of Interventional Radiology, Department of Radiology, University of Chicago, Chicago, Illinois, United States
| | - Jeffrey A. Leef
- Section of Interventional Radiology, Department of Radiology, University of Chicago, Chicago, Illinois, United States
| | - Osman Ahmed
- Section of Interventional Radiology, Department of Radiology, University of Chicago, Chicago, Illinois, United States
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4
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Houghton EJ, Rubio JS. Surgical management of the postoperative complications of hepato-pancreato-biliary surgery. INTERNATIONAL JOURNAL OF GASTROINTESTINAL INTERVENTION 2022. [DOI: 10.18528/ijgii220041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Affiliation(s)
- Eduardo Javier Houghton
- Teaching and Research Department, DAICIM Foundation, Buenos Aires, Argentina
- Surgery Division, B. Rivadavia Hospital, Buenos Aires, Argentina
- Department of Surgery, School of Medicine, University of Buenos Aires, Buenos Aires, Argentina
| | - Juan Santiago Rubio
- Solid Organ Transplant Service, Hospital de Alta Complejidad en Red El Cruce Dr. Néstor Carlos Kirchner, Buenos Aires, Argentina
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Bakalli I, Biqiku M, Cela D, Demrozi A, Kola E, Celaj E, Gjeta I, Sala D, Klironomi D. Atraumatic splenic rupture in a child with COVID 19. BMC Pediatr 2022; 22:300. [PMID: 35597923 PMCID: PMC9124052 DOI: 10.1186/s12887-022-03353-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/05/2021] [Accepted: 05/11/2022] [Indexed: 11/10/2022] Open
Abstract
Background The majority of children with COVID-19 have only minor symptoms or none at all. COVID-19, on the other hand, can cause serious illness in some children, necessitating hospitalization, intensive care, and invasive ventilation. Many studies have revealed that SARS-CoV-2 affects not only the respiratory system, but also other vital organs in the body. We report here a child with an atraumatic splenic rupture as the initial and only manifestation of COVID-19. Case presentation A 13-year-old boy with clinical signs of acute abdomen, left-sided abdominal pain, and hemodynamic instability was admitted to the PICU in critical condition. His parents denied any trauma had occurred. In addition to imaging tests, a nasopharyngeal swab was taken for COVID-19 testing, which was positive. The thoracic CT scan was normal, whereas the abdominal CT scan revealed hemoperitoneum, splenic rupture, and free fluid in the abdomen. Conclusions The spleen is one of the organs targeted by the SARS-CoV-2. Splenic rupture, a potentially fatal and uncommon complication of COVID-19, can be the first and only clinical manifestation of the disease in children. All pediatricians should be aware of the possibility of atraumatic splenic rupture in children with COVID-19.
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Affiliation(s)
| | | | - Durim Cela
- Department of Radiology, UHC "Mother Theresa", Tirane, Albania
| | | | | | | | - Inva Gjeta
- PICU, UHC "Mother Theresa", Tirane, Albania
| | - Durim Sala
- PICU, UHC "Mother Theresa", Tirane, Albania
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6
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Kumar S, Gupta A, Sagar S, Bagaria D, Kumar A, Choudhary N, Kumar V, Ghoshal S, Alam J, Agarwal H, Gammangatti S, Kumar A, Soni KD, Agarwal R, Gunjaganvi M, Joshi M, Saurabh G, Banerjee N, Kumar A, Rattan A, Bakhshi GD, Jain S, Shah S, Sharma P, Kalangutkar A, Chatterjee S, Sharma N, Noronha W, Mohan LN, Singh V, Gupta R, Misra S, Jain A, Dharap S, Mohan R, Priyadarshini P, Tandon M, Mishra B, Jain V, Singhal M, Meena YK, Sharma B, Garg PK, Dhagat P, Kumar S, Kumar S, Misra MC. Management of Blunt Solid Organ Injuries: the Indian Society for Trauma and Acute Care (ISTAC) Consensus Guidelines. Indian J Surg 2021. [DOI: 10.1007/s12262-021-02820-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
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7
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Coccolini F, Coimbra R, Ordonez C, Kluger Y, Vega F, Moore EE, Biffl W, Peitzman A, Horer T, Abu-Zidan FM, Sartelli M, Fraga GP, Cicuttin E, Ansaloni L, Parra MW, Millán M, DeAngelis N, Inaba K, Velmahos G, Maier R, Khokha V, Sakakushev B, Augustin G, di Saverio S, Pikoulis E, Chirica M, Reva V, Leppaniemi A, Manchev V, Chiarugi M, Damaskos D, Weber D, Parry N, Demetrashvili Z, Civil I, Napolitano L, Corbella D, Catena F. Liver trauma: WSES 2020 guidelines. World J Emerg Surg 2020; 15:24. [PMID: 32228707 PMCID: PMC7106618 DOI: 10.1186/s13017-020-00302-7] [Citation(s) in RCA: 123] [Impact Index Per Article: 30.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2020] [Accepted: 03/06/2020] [Indexed: 02/06/2023] Open
Abstract
Liver injuries represent one of the most frequent life-threatening injuries in trauma patients. In determining the optimal management strategy, the anatomic injury, the hemodynamic status, and the associated injuries should be taken into consideration. Liver trauma approach may require non-operative or operative management with the intent to restore the homeostasis and the normal physiology. The management of liver trauma should be multidisciplinary including trauma surgeons, interventional radiologists, and emergency and ICU physicians. The aim of this paper is to present the World Society of Emergency Surgery (WSES) liver trauma management guidelines.
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Affiliation(s)
- Federico Coccolini
- General, Emergency and Trauma Surgery Department, Pisa University Hospital, Via Paradisia 1, 56100, Pisa, Italy.
| | - Raul Coimbra
- Riverside University Health System, CECORC Research Center, Loma Linda University, Loma Linda, USA
| | - Carlos Ordonez
- Division of Trauma and Acute Care Surgery, Fundación Valle del Lili, Cali, Colombia
| | - Yoram Kluger
- Division of General Surgery, Rambam Health Care Campus Haifa, Haifa, Israel
| | - Felipe Vega
- Department of Surgery, Hospital Angeles Lomas, Huixquilucan, Mexico
| | | | - Walt Biffl
- Trauma Surgery Department, Scripps Memorial Hospital La Jolla, San Diego, CA, USA
| | - Andrew Peitzman
- Surgery Department, University of Pittsburgh, Pittsburgh, PA, USA
| | - Tal Horer
- Department of Cardiothoracic and Vascular Surgery, Örebro University Hospital, Örebro University, Örebro, Sweden.,Department of Surgery, Örebro University Hospital, Örebro University, Örebro, Sweden
| | - Fikri M Abu-Zidan
- Department of Surgery, College of Medicine and Health Sciences, UAE University, Al-Ain, United Arab Emirates
| | - Massimo Sartelli
- General and Emergency Surgery, Macerata Hospital, Macerata, Italy
| | - Gustavo P Fraga
- Trauma/Acute Care Surgery & Surgical Critical Care, University of Campinas, Campinas, Brazil
| | - Enrico Cicuttin
- General, Emergency and Trauma Surgery Department, Pisa University Hospital, Via Paradisia 1, 56100, Pisa, Italy
| | - Luca Ansaloni
- General, Emergency and Trauma Surgery Department, Bufalini Hospital, Cesena, Italy
| | - Michael W Parra
- Department of Trauma Critical Care, Broward General Level I Trauma Center, Fort Lauderdale, FL, USA
| | - Mauricio Millán
- Division of Trauma and Acute Care Surgery, Fundación Valle del Lili, Cali, Colombia
| | - Nicola DeAngelis
- Unit of Digestive Surgery, HPB Surgery and Liver Transplant, Henri Mondor Hospital, Créteil, France
| | - Kenji Inaba
- General and Trauma Surgery, LAC+USC Medical Center, Los Angeles, CA, USA
| | - George Velmahos
- General and Emergency Surgery, Massachusetts General Hospital, Boston, MA, USA
| | - Ron Maier
- Department of Surgery, Harborview Medical Centre, Seattle, USA
| | - Vladimir Khokha
- General Surgery Department, Mozir City Hospital, Mozir, Belarus
| | - Boris Sakakushev
- General Surgery Department, Medical University, University Hospital St George, Plovdiv, Bulgaria
| | - Goran Augustin
- Department of Surgery, Zagreb University Hospital Centre and School of Medicine, University of Zagreb, Zagreb, Croatia
| | - Salomone di Saverio
- General and Trauma Surgery Addenbrooke's Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - Emanuil Pikoulis
- 3rd Department of Surgery, Attiko Hospital, National & Kapodistrian University of Athens, Athens, Greece
| | - Mircea Chirica
- Chirurgie Digestive, CHUGA-CHU Grenoble Alpes, Grenoble, France
| | - Viktor Reva
- General and Emergency Surgery, Sergei Kirov Military Academy, Saint Petersburg, Russia
| | - Ari Leppaniemi
- General Surgery Department, Mehilati Hospital, Helsinki, Finland
| | - Vassil Manchev
- General and Trauma Surgery Department, Pietermaritzburg Hospital, Pietermaritzburg, South Africa
| | - Massimo Chiarugi
- General, Emergency and Trauma Surgery Department, Pisa University Hospital, Via Paradisia 1, 56100, Pisa, Italy
| | | | - Dieter Weber
- Department of General Surgery, Royal Perth Hospital, Perth, Australia
| | - Neil Parry
- General and Trauma Surgery Department, London Health Sciences Centre, Victoria Hospital, London, ON, Canada
| | | | - Ian Civil
- Trauma Surgery, Auckland University Hospital, Auckland, New Zealand
| | - Lena Napolitano
- Division of Acute Care Surgery, University of Michigan Health System, Ann Arbor, MI, USA
| | | | - Fausto Catena
- Emergency and Trauma Surgery, Maggiore Hospital, Parma, Italy
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8
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Fan J, Tekin A, Tzakis A, Misra S. Liver Transplantation Following Life-threatening Abdominal Trauma: A Case Series of 5 Patients at a Single Institution. Transplant Proc 2019; 51:1902-1906. [PMID: 31155306 DOI: 10.1016/j.transproceed.2019.04.042] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2019] [Revised: 04/01/2019] [Accepted: 04/22/2019] [Indexed: 12/11/2022]
Abstract
Managing traumatic liver injury (TLI) is always challenging and demands precise clinical judgment. Currently, treatment of TLI in most circumstances is non-operative; however, surgical therapy might be required for severe TLI, particularly those that result in extensive blood loss. In the current institutional study carried out from June 1995 to April 2017, we describe our experience with 5 patients who received an orthotopic liver transplant for severe TLI. One patient passed away postoperatively from cerebral edema; 1 patient died of renal failure 4 years after the liver transplantation, and 3 patients are still alive. Based on our experience, we conclude that in patients with TLI, especially those with uncontrollable bleeding or those who develop liver failure, liver transplantation should be taken into consideration.
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Affiliation(s)
- Ji Fan
- Brandon Regional Medical Center, Brandon, FL, United States; Miami Transplant Institute, University of Miami, Miami, FL, United States.
| | - Akin Tekin
- Miami Transplant Institute, University of Miami, Miami, FL, United States
| | | | - Subhasis Misra
- Brandon Regional Medical Center, Brandon, FL, United States
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9
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Brillantino A, Iacobellis F, Festa P, Mottola A, Acampora C, Corvino F, Del Giudice S, Lanza M, Armellino M, Niola R, Romano L, Castriconi M, De Palma M, Noschese G. Non-Operative Management of Blunt Liver Trauma: Safety, Efficacy and Complications of a Standardized Treatment Protocol. Bull Emerg Trauma 2019; 7:49-54. [PMID: 30719466 PMCID: PMC6360015 DOI: 10.29252/beat-070107] [Citation(s) in RCA: 36] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023] Open
Abstract
Objective: To evaluate the safety and effectiveness of NOM (non-operative management) in the treatment of blunt liver trauma, following a standardized treatment protocol. Methods: All the hemodynamically stable patients with computed tomography (CT) diagnosis of blunt liver trauma underwent NOM. It included strict clinical and laboratory observation, 48-72h contrast enhanced ultrasonography (CEUS) or CT follow-up, a primary angioembolization in case of admission CT evidence of vascular injuries and a secondary angioembolization in presence of vascular injuries signs at follow-up CEUS. Results: 181 patients (85.4%) [55 (30.4%) women and 126 (69.6%) men, median age 39 (range 14–71)] were included. Of these, 63 patients (34.8%) had grade I, 48 patients (26.5%) grade II, 39 patients (21.5%) grade III, 21 patients (11.6%) grade IV and 10 patients (5.5%) grade V liver injuries. The overall success rate of NOM was 96.7% (175/181). There was not significant difference in the success rate between the patients with different liver injuries grade. Morbidity rate was 7.4% (13/175). Major complications (2 bilomas, 1 liver hematoma and 2 liver abscesses) were successfully treated by CEUS or CT guided drainage. Eighteen (18/181) patients (9.9%) underwent angioembolization with successful results. Conclusion: Non-operative management of blunt liver trauma represents a safe and effective treatment for both minor and severe injuries, achieving an high success rate and an acceptable morbidity rate. The angiographic study with embolization, although required only in selected cases of vascular injuries, represents a fundamental therapeutic option in a significant percentage of patients.
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Affiliation(s)
- Antonio Brillantino
- Department of Surgery, A. Cardarelli Hospital, Via A. Cardarelli 9 80131 Naples, Italy.,Antonio Brillantino and Francesca Iacobellis are equally contributors
| | - Francesca Iacobellis
- Department of Radiology, A. Cardarelli Hospital, Via A. Cardarelli 9 80131 Naples, Italy.,Antonio Brillantino and Francesca Iacobellis are equally contributors
| | - Patrizio Festa
- Department of Surgery, A. Cardarelli Hospital, Via A. Cardarelli 9 80131 Naples, Italy
| | - Arianna Mottola
- Department of Surgery, A. Cardarelli Hospital, Via A. Cardarelli 9 80131 Naples, Italy
| | - Ciro Acampora
- Department of Radiology, A. Cardarelli Hospital, Via A. Cardarelli 9 80131 Naples, Italy
| | - Fabio Corvino
- Interventional Radiology Department, A Cardarelli Hospital, Via A. Cardarelli 9 80131 Naples, Italy
| | - Santolo Del Giudice
- Department of Surgery, A. Cardarelli Hospital, Via A. Cardarelli 9 80131 Naples, Italy
| | - Michele Lanza
- Department of Surgery, A. Cardarelli Hospital, Via A. Cardarelli 9 80131 Naples, Italy
| | - Mariano Armellino
- Department of Surgery, A. Cardarelli Hospital, Via A. Cardarelli 9 80131 Naples, Italy
| | - Raffaella Niola
- Interventional Radiology Department, A Cardarelli Hospital, Via A. Cardarelli 9 80131 Naples, Italy
| | - Luigia Romano
- Department of Radiology, A. Cardarelli Hospital, Via A. Cardarelli 9 80131 Naples, Italy
| | - Maurizio Castriconi
- Department of Surgery, A. Cardarelli Hospital, Via A. Cardarelli 9 80131 Naples, Italy
| | - Maurizio De Palma
- Department of Surgery, A. Cardarelli Hospital, Via A. Cardarelli 9 80131 Naples, Italy
| | - Giuseppe Noschese
- Department of Surgery, A. Cardarelli Hospital, Via A. Cardarelli 9 80131 Naples, Italy
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10
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Mowery NT, Butts CC, Call EB. Current Management of Splenic Injuries: Who Needs a Splenectomy? CURRENT SURGERY REPORTS 2018. [DOI: 10.1007/s40137-018-0211-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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11
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Coccolini F, Catena F, Moore EE, Ivatury R, Biffl W, Peitzman A, Coimbra R, Rizoli S, Kluger Y, Abu-Zidan FM, Ceresoli M, Montori G, Sartelli M, Weber D, Fraga G, Naidoo N, Moore FA, Zanini N, Ansaloni L. WSES classification and guidelines for liver trauma. World J Emerg Surg 2016; 11:50. [PMID: 27766112 PMCID: PMC5057434 DOI: 10.1186/s13017-016-0105-2] [Citation(s) in RCA: 73] [Impact Index Per Article: 9.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2016] [Accepted: 09/13/2016] [Indexed: 11/10/2022] Open
Abstract
The severity of liver injuries has been universally classified according to the American Association for the Surgery of Trauma (AAST) grading scale. In determining the optimal treatment strategy, however, the haemodynamic status and associated injuries should be considered. Thus the management of liver trauma is ultimately based on the anatomy of the injury and the physiology of the patient. This paper presents the World Society of Emergency Surgery (WSES) classification of liver trauma and the management Guidelines.
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Affiliation(s)
- Federico Coccolini
- General Emergency and Trauma Surgery Department, Papa Giovanni XXIII Hospital, Piazza OMS 1, 24127 Bergamo, Italy
| | - Fausto Catena
- Emergency and Trauma Surgery, Parma Maggiore Hospital, Parma, Italy
| | | | - Rao Ivatury
- Virginia Commonwealth University, Richmond, VA USA
| | - Walter Biffl
- Acute Care Surgery, The Queen's Medical Center, Honolulu, HI USA
| | - Andrew Peitzman
- Department of Surgery, Trauma and Surgical Services, University of Pittsburgh School of Medicine, Pittsburgh, USA
| | - Raul Coimbra
- Department of Surgery, UC San Diego Health System, San Diego, USA
| | - Sandro Rizoli
- Trauma & Acute Care Service, St Michael's Hospital, Toronto, ON Canada
| | - Yoram Kluger
- Division of General Surgery Rambam Health Care Campus, Haifa, Israel
| | - Fikri M Abu-Zidan
- Department of Surgery, College of Medicine and Health Sciences, UAE University, Al-Ain, United Arab Emirates
| | - Marco Ceresoli
- General Emergency and Trauma Surgery Department, Papa Giovanni XXIII Hospital, Piazza OMS 1, 24127 Bergamo, Italy
| | - Giulia Montori
- General Emergency and Trauma Surgery Department, Papa Giovanni XXIII Hospital, Piazza OMS 1, 24127 Bergamo, Italy
| | | | - Dieter Weber
- Department of General Surgery, Royal Perth Hospital, Perth, Australia
| | - Gustavo Fraga
- Faculdade de Ciências Médicas (FCM)-Unicamp, Campinas, SP Brazil
| | - Noel Naidoo
- Department of Surgery, University of KwaZulu-Natal, Durban, South Africa
| | | | - Nicola Zanini
- General Surgery Department, Infermi Hospital, Rimini, Italy
| | - Luca Ansaloni
- General Emergency and Trauma Surgery Department, Papa Giovanni XXIII Hospital, Piazza OMS 1, 24127 Bergamo, Italy
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12
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Zeidenberg J, Durso AM, Caban K, Munera F. Imaging of Penetrating Torso Trauma. Semin Roentgenol 2016; 51:239-55. [DOI: 10.1053/j.ro.2016.03.004] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
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13
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Peri-hepatic gauze packing for the control of haemorrhage during liver transplantation: A retrospective study. Dig Liver Dis 2016; 48:414-22. [PMID: 26725163 DOI: 10.1016/j.dld.2015.11.018] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2015] [Revised: 11/11/2015] [Accepted: 11/20/2015] [Indexed: 12/11/2022]
Abstract
BACKGROUND Albeit accepted in the trauma setting, use of peri-hepatic gauze packing has been rarely reported during liver transplantation. AIMS To assess the results of packing in liver transplantation. METHODS We reviewed clinical characteristics, intraoperative events and postoperative outcome of consecutive adult liver transplantation recipients between 2003 and 2013. Patients treated with packing were compared to no-packing patients and to matched controls selected using a propensity score. RESULTS Of 1396 recipients, 107 were treated with packing for peri-hepatic bleeding (76.6%), allograft damage (12.1%) or partial outflow obstruction (11.2%). Urgent reoperation for ongoing haemorrhage was required in 6 (5.6%). Correction of haemodynamic and coagulation parameters was constantly achieved. Overall, patient (90% vs. 98%, p<0.001) and graft (83.2% vs. 94.7%, p<0.001) 3-month survival was significantly reduced in packing patients. However, after matching, no significant difference was observed in patient (89.3% vs. 95.2%, p=0.12) and graft (83.5% vs. 92.2%, p=0.06) 3-month survival. Patient survival was associated with recipient age (HR 2.59; p=0.04) and donor age × recipient MELD (HR 2.04; p=0.02), but not with packing (HR 1.81; p=0.29). CONCLUSIONS In our experience, packing was a valuable adjunct to conventional means of haemostasis during liver transplantation and, after accounting for confounding covariates, was not associated with inferior outcomes.
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Abstract
The use of computed tomography (CT) for hemodynamically stable victims of penetrating torso trauma continues to increase but remains less singular to the work-up than in blunt trauma. Research in this area has focused on the incremental benefits of CT within the context of evolving diagnostic algorithms and in conjunction with techniques such as laparoscopy, endoscopy, and angiographic intervention. This review centers on the current state of multidetector CT as a triage tool for penetrating torso trauma and the primacy of trajectory evaluation in diagnosis, while emphasizing diagnostic challenges that have lingered despite tremendous technological advances since CT was first used in this setting 3 decades ago. As treatment strategies have also changed considerably over the years in parallel with advances in CT, current management implications of organ-specific injuries depicted at multidetector CT are also discussed.
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Affiliation(s)
- David Dreizin
- From the Department of Diagnostic Radiology and Nuclear Medicine, University of Maryland Medical Center, R Adams Cowley Shock Trauma Center, 22 S Greene St, Baltimore, MD 21201 (D.D.); and Department of Diagnostic Radiology, University of Miami Leonard Miller School of Medicine, Jackson Memorial Hospital & Ryder Trauma Center, Miami Fla (F.M.)
| | - Felipe Munera
- From the Department of Diagnostic Radiology and Nuclear Medicine, University of Maryland Medical Center, R Adams Cowley Shock Trauma Center, 22 S Greene St, Baltimore, MD 21201 (D.D.); and Department of Diagnostic Radiology, University of Miami Leonard Miller School of Medicine, Jackson Memorial Hospital & Ryder Trauma Center, Miami Fla (F.M.)
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Brillantino A, Iacobellis F, Robustelli U, Villamaina E, Maglione F, Colletti O, De Palma M, Paladino F, Noschese G. Non operative management of blunt splenic trauma: a prospective evaluation of a standardized treatment protocol. Eur J Trauma Emerg Surg 2015; 42:593-598. [DOI: 10.1007/s00068-015-0575-z] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2015] [Accepted: 09/03/2015] [Indexed: 11/28/2022]
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Coccolini F, Montori G, Catena F, Di Saverio S, Biffl W, Moore EE, Peitzman AB, Rizoli S, Tugnoli G, Sartelli M, Manfredi R, Ansaloni L. Liver trauma: WSES position paper. World J Emerg Surg 2015; 10:39. [PMID: 26309445 PMCID: PMC4548919 DOI: 10.1186/s13017-015-0030-9] [Citation(s) in RCA: 45] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2015] [Accepted: 07/24/2015] [Indexed: 01/13/2023] Open
Abstract
The liver is the most injured organ in abdominal trauma. Road traffic crashes and antisocial, violent behavior account for the majority of liver injuries. The present position paper represents the position of the World Society of Emergency Surgery (WSES) about the management of liver injuries.
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Affiliation(s)
- Federico Coccolini
- General, Emergency and Trauma Surgery, Papa Giovanni XXIII Hospital, P.zza OMS 1, 24128 Bergamo, Italy
| | - Giulia Montori
- General, Emergency and Trauma Surgery, Papa Giovanni XXIII Hospital, P.zza OMS 1, 24128 Bergamo, Italy
| | - Fausto Catena
- Emergency and Trauma Surgery, Maggiore Hospital, Parma, Italy
| | | | | | | | - Andrew B Peitzman
- Surgery Department, University of Pittsburgh, Pittsburgh, Pensylvania USA
| | - Sandro Rizoli
- Trauma & Acute Care Service, St Michael's Hospital, Toronto, ON Canada
| | - Gregorio Tugnoli
- General, Emergency and Trauma Surgery, Maggiore Hospital, Bologna, Italy
| | - Massimo Sartelli
- General and Emergency Surgery, Macerata Hospital, Macerata, Italy
| | - Roberto Manfredi
- General and Emergency Surgery, Macerata Hospital, Macerata, Italy
| | - Luca Ansaloni
- General, Emergency and Trauma Surgery, Papa Giovanni XXIII Hospital, P.zza OMS 1, 24128 Bergamo, Italy
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Sbai H, Boukatta B, El Bouazzaoui A, Youssfi M, Mellouki I, Benajeh DA, Bobo M, Bohadouti H, Tizniti S, Ibrahimi A, Taleb KA, Kanjaa N. [Rare complication of colonoscopy in a patient on anticoagulant: haemoperitoneum by rupture of a subcapsular hematoma of the spleen, clinical case]. Pan Afr Med J 2015; 21:232. [PMID: 26523174 PMCID: PMC4607983 DOI: 10.11604/pamj.2015.21.232.1920] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2012] [Accepted: 03/19/2013] [Indexed: 01/10/2023] Open
Abstract
La coloscopie à visée diagnostique et/ou thérapeutique est un examen invasif fréquemment pratiquée de nos jours. La perforation colique et l'hémorragie digestive en sont les principales complications. La survenue d'un hémopéritoine par rupture d'un hématome sous-capsulaire splénique est une complication extrêmement rare et potentiellement mortelle de la coloscopie. Un traumatisme splénique minime passé inaperçu et la prise d'anticoagulant en sont des facteurs favorisants. Nous présentons le cas d'une rupture d'un hématome sous-capsulaire de la rate après une coloscopie, survenue chez un patient de 70 ans porteur d'une valve mitrale mécanique sous acénocoumarol à dose hypocaogulante. La nécessité d'obtention d'une anti coagulation rapidement efficace et l'instabilité hémodynamique avaient justifiée la réalisation d'une splénectomie. L’évolution était favorable. A travers cette observation clinique nous discutons les mécanismes et les modalités de prise en charge devant cette complication.
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Affiliation(s)
- Hicham Sbai
- Service d'Anesthésie Réanimation A4, CHU Hassan II, Fès, Maroc
| | - Brahim Boukatta
- Service d'Anesthésie Réanimation A4, CHU Hassan II, Fès, Maroc
| | | | | | | | | | - Meriem Bobo
- Service de Chirurgie Viscérale, CHU Hassan II, Fès, Maroc
| | | | - Siham Tizniti
- Service de Chirurgie Viscérale, CHU Hassan II, Fès, Maroc
| | - Adil Ibrahimi
- Service de Gastroentérologie, CHU Hassan II, Fès, Maroc
| | | | - Nabil Kanjaa
- Service d'Anesthésie Réanimation A4, CHU Hassan II, Fès, Maroc
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MDCT of complications and common postoperative findings following penetrating torso trauma. Emerg Radiol 2015; 22:553-63. [PMID: 26013026 DOI: 10.1007/s10140-015-1325-6] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2015] [Accepted: 05/18/2015] [Indexed: 12/21/2022]
Abstract
Victims of penetrating torso trauma often present with findings that necessitate emergent exploratory laparotomy, precluding scanning with multidetector computed tomography (MDCT) until the postoperative period. This article reviews the wide range of complications as well as expected findings that may be encountered at MDCT performed postoperatively. Little has been written to guide the radiologist in interpreting these often complex and potentially confusing studies.
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Abstract
Abdominal trauma represents the leading cause of haemorrhagic shock in the severely injured patient and is associated with high mortality and morbidity rates. The trauma surgeon has a central role in the multidisciplinary team addressing the specific diagnostic and therapeutic needs of patients with abdominal trauma. The management of blunt and penetrating abdominal trauma has undergone substantial changes in recent decades. Major innovations have been established in the field of diagnostic imaging and of nonoperative interventions such as angioembolization and endoscopic procedures. Another key development is the introduction of the damage control concept for the care of patients with abdominal trauma. The present manuscript comprises a review of the current management of abdominal trauma with an emphasis on diagnostic and therapeutic innovations.
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21
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Lam GY, Chan AK, Powis JE. Possible infectious causes of spontaneous splenic rupture: a case report. J Med Case Rep 2014; 8:396. [PMID: 25433804 PMCID: PMC4289345 DOI: 10.1186/1752-1947-8-396] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2014] [Accepted: 09/26/2014] [Indexed: 12/26/2022] Open
Abstract
Introduction Spontaneous atraumatic splenic rupture is a rare but dramatic occurrence that is most commonly attributed to infection or neoplasia. Deciphering the etiology can be challenging with many cases remaining unclear despite full investigation. Case presentation We report the case of a previously healthy and immunocompetent 52-year-old Caucasian woman with a remote history of clinically diagnosed infectious mononucleosis who experienced sudden atraumatic splenic rupture after an untreated stray cat bite. Conclusions The differential diagnosis for atraumatic splenic rupture, specifically its infectious causes, is reviewed. Key clinical and laboratory findings that differentiate Bartonella henselae infection and Epstein–Barr virus reinfection are reviewed.
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Affiliation(s)
| | | | - Jeff E Powis
- Department of Infectious Diseases, Toronto East General Hospital, 825 Coxwell Ave, Toronto, ON, M4C 3E7, Canada.
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Swaid F, Peleg K, Alfici R, Matter I, Olsha O, Ashkenazi I, Givon A, Kessel B. Concomitant hollow viscus injuries in patients with blunt hepatic and splenic injuries: an analysis of a National Trauma Registry database. Injury 2014; 45:1409-12. [PMID: 24656303 DOI: 10.1016/j.injury.2014.02.027] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2014] [Revised: 02/12/2014] [Accepted: 02/20/2014] [Indexed: 02/02/2023]
Abstract
INTRODUCTION Non-operative management has become the standard approach for treating stable patients sustaining blunt hepatic or splenic injuries in the absence of other indications for laparotomy. The liberal use of computed tomography (CT) has reduced the rate of unnecessary immediate laparotomies; however, due to its limited sensitivity in the diagnosis of hollow viscus injuries (HVI), this may be at the expense of a rise in the incidence of missed HVI. The aim of this study was to assess the incidence of concomitant HVI in blunt trauma patients diagnosed with hepatic and/or splenic injuries, and to evaluate whether a correlation exists between this incidence and the severity of hepatic or splenic injuries. METHODS A retrospective cohort study involving blunt trauma patients with splenic and/or liver injuries, between the years 1998 and 2012 registered in the Israel National Trauma Registry. The association between the presence and severity of splenic and/or liver injuries and the incidence of HVI was examined. RESULTS Of the 57,130 trauma victims identified as suffering from blunt torso injuries, 2335 (4%) sustained hepatic injuries without splenic injuries (H group), 3127 (5.4%) had splenic injuries without hepatic injuries (S group), and 564 (1%) suffered from both hepatic and splenic injuries (H+S group). Overall, 957 patients sustained 1063 HVI. The incidence of HVI among blunt torso trauma victims who sustained neither splenic nor hepatic injuries was 1.5% which is significantly lower than in the S (3.1%), H (3.1%), and H+S (6.7%) groups. In the S group, there was a clear correlation between the severity of the splenic injury and the incidence of HVI. This correlation was not found in the H group. CONCLUSIONS The presence of blunt splenic and/or hepatic injuries predicts a higher incidence of HVI, especially if combined. While in blunt splenic injury patients there is a clear correlation between the incidence of HVI and the severity of splenic injury, such a correlation does not exist in patients with blunt hepatic injury.
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Affiliation(s)
- Forat Swaid
- General Surgery Department, Bnai-Zion Medical Center, Haifa, Israel.
| | - Kobi Peleg
- National Center for Trauma and Emergency Medicine Research, Gertner Institute for Epidemiology and Health Policy Research, Tel Hashomer, Israel
| | - Ricardo Alfici
- Surgical Division, Hillel Yaffe Medical Center, Hadera, Israel
| | - Ibrahim Matter
- General Surgery Department, Bnai-Zion Medical Center, Haifa, Israel
| | - Oded Olsha
- Surgery Department, Shaare Zedek Medical Center, Jerusalem, Israel
| | | | - Adi Givon
- National Center for Trauma and Emergency Medicine Research, Gertner Institute for Epidemiology and Health Policy Research, Tel Hashomer, Israel
| | | | - Boris Kessel
- Trauma Unit, Hillel Yaffe Medical Center, Hadera, Israel
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Pekkari P, Bylund PO, Lindgren H, Öman M. Abdominal injuries in a low trauma volume hospital--a descriptive study from northern Sweden. Scand J Trauma Resusc Emerg Med 2014; 22:48. [PMID: 25124882 PMCID: PMC4237946 DOI: 10.1186/s13049-014-0048-0] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2014] [Accepted: 08/05/2014] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Abdominal injuries occur relatively infrequently during trauma, and they rarely require surgical intervention. In this era of non-operative management of abdominal injuries, surgeons are seldom exposed to these patients. Consequently, surgeons may misinterpret the mechanism of injury, underestimate symptoms and radiologic findings, and delay definite treatment. Here, we determined the incidence, diagnosis, and treatment of traumatic abdominal injuries at our hospital to provide a basis for identifying potential hazards in non-operative management of patients with these injuries in a low trauma volume hospital. METHODS This retrospective study included prehospital and in-hospital assessments of 110 patients that received 147 abdominal injuries from an isolated abdominal trauma (n = 70 patients) or during multiple trauma (n = 40 patients). Patients were primarily treated at the University Hospital of Umeå from January 2000 to December 2009. RESULTS The median New Injury Severity Score was 9 (range: 1-57) for 147 abdominal injuries. Most patients (94%) received computed tomography (CT), but only 38% of patients with multiple trauma were diagnosed with CT < 60 min after emergency room arrival. Penetrating trauma caused injuries in seven patients. Solid organ injuries constituted 78% of abdominal injuries. Non-operative management succeeded in 82 patients. Surgery was performed for 28 patients, either immediately (n = 17) as result of operative management or later (n = 11), due to non-operative management failure; the latter mainly occurred with hollow viscus injuries. Patients with multiple abdominal injuries, whether associated with multiple trauma or an isolated abdominal trauma, had significantly more non-operative failures than patients with a single abdominal injury. One death occurred within 30 days. CONCLUSIONS Non-operative management of patients with abdominal injuries, except for hollow viscus injuries, was highly successful in our low trauma volume hospital, even though surgeons receive low exposure to these patients. However, a growing proportion of surgeons lack experience in decision-making and performing trauma laparotomies. Quality assurance programmes must be emphasized to ensure future competence and quality of trauma care at low trauma volume hospitals.
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Affiliation(s)
| | | | | | - Mikael Öman
- Department of Surgical and Perioperative Sciences; Surgery, Umea University, Umea, SE-901 85, Sweden.
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Patrono D, Brunati A, Romagnoli R, Salizzoni M. Liver transplantation after severe hepatic trauma: a sustainable practice. A single-center experience and review of the literature. Clin Transplant 2014; 27:E528-37. [PMID: 23923975 DOI: 10.1111/ctr.12192] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/22/2013] [Indexed: 12/20/2022]
Abstract
Severe hepatic trauma is a rare indication for liver transplantation (LT). We report our single-center experience of LT for hepatic trauma. Four new cases are discussed in light of a literature review in order to depict the pathways leading from hepatic trauma to LT and to assess the outcomes of this practice. LT is generally indicated in case of uncontrollable hemorrhage, acute liver failure, or post-traumatic late sequelae. Hepatic vessels thrombosis, sepsis, major hepatic resections, and a late referral are factors associated with the progression toward irreversible liver failure. Considering all reported cases, early patient and graft survival reached 68% and 62%, respectively, but in the last decade both have improved to 84%. LT after severe hepatic trauma is a sustainable practice considering the current good outcomes and the ineluctable death of these patients without LT.
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Affiliation(s)
- Damiano Patrono
- General Surgery 8 and Liver Transplantation Center, San Giovanni Battista - Molinette University Hospital, A. O. Città della Salute e della Scienza, Turin, Italy
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Cirocchi R, Boselli C, Corsi A, Farinella E, Listorti C, Trastulli S, Renzi C, Desiderio J, Santoro A, Cagini L, Parisi A, Redler A, Noya G, Fingerhut A. Is non-operative management safe and effective for all splenic blunt trauma? A systematic review. CRITICAL CARE : THE OFFICIAL JOURNAL OF THE CRITICAL CARE FORUM 2013; 17:R185. [PMID: 24004931 PMCID: PMC4056798 DOI: 10.1186/cc12868] [Citation(s) in RCA: 60] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/05/2012] [Accepted: 09/03/2013] [Indexed: 01/16/2023]
Abstract
Introduction The goal of non-operative management (NOM) for blunt splenic trauma (BST) is to preserve the spleen. The advantages of NOM for minor splenic trauma have been extensively reported, whereas its value for the more severe splenic injuries is still debated. The aim of this systematic review was to evaluate the available published evidence on NOM in patients with splenic trauma and to compare it with the operative management (OM) in terms of mortality, morbidity and duration of hospital stay. Methods For this systematic review we followed the "Preferred Reporting Items for Systematic Reviews and Meta-analyses" statement. A systematic search was performed on PubMed for studies published from January 2000 to December 2011, without language restrictions, which compared NOM vs. OM for splenic trauma injuries and which at least 10 patients with BST. Results We identified 21 non randomized studies: 1 Clinical Controlled Trial and 20 retrospective cohort studies analyzing a total of 16,940 patients with BST. NOM represents the gold standard treatment for minor splenic trauma and is associated with decreased mortality in severe splenic trauma (4.78% vs. 13.5% in NOM and OM, respectively), according to the literature. Of note, in BST treated operatively, concurrent injuries accounted for the higher mortality. In addition, it was not possible to determine post-treatment morbidity in major splenic trauma. The definition of hemodynamic stability varied greatly in the literature depending on the surgeon and the trauma team, representing a further bias. Moreover, data on the remaining analyzed outcomes (hospital stay, number of blood transfusions, abdominal abscesses, overwhelming post-splenectomy infection) were not reported in all included studies or were not comparable, precluding the possibility to perform a meaningful cumulative analysis and comparison. Conclusions NOM of BST, preserving the spleen, is the treatment of choice for the American Association for the Surgery of Trauma grades I and II. Conclusions are more difficult to outline for higher grades of splenic injury, because of the substantial heterogeneity of expertise among different hospitals, and potentially inappropriate comparison groups.
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[Management of penetrating abdominal trauma: what we need to know?]. ACTA ACUST UNITED AC 2013; 32:104-11. [PMID: 23402982 DOI: 10.1016/j.annfar.2012.12.006] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2012] [Accepted: 12/13/2012] [Indexed: 12/25/2022]
Abstract
Penetrating traumas are rare in France and mainly due to stabbing. Knives are less lethal than firearms. The initial clinical assessment is the cornerstone of hospital care. It remains a priority and can quickly lead to a surgical treatment first. Urgent surgical indications are hemorrhagic shock, evisceration and peritonitis. Dying patients should be immediately taken to the operating room for rescue laparotomy or thoracotomy. Ultrasonography and chest radiography are performed before damage control surgery for hemodynamic unstable critical patients. Stable patients are scanned by CT and in some cases may benefit from non-operative strategy. Mortality remains high, initially due to bleeding complications and secondarily to infectious complications. Early and appropriate surgery can reduce morbidity and mortality. Non-operative strategy is only possible in selected patients in trained trauma centers and with intensive supervision by experienced staff.
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Minimally Invasive Procedures for Liver Trauma. Updates Surg 2013. [DOI: 10.1007/978-88-470-2664-3_17] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Di Saverio S, Moore EE, Tugnoli G, Naidoo N, Ansaloni L, Bonilauri S, Cucchi M, Catena F. Non operative management of liver and spleen traumatic injuries: a giant with clay feet. World J Emerg Surg 2012; 7:3. [PMID: 22269102 PMCID: PMC3275476 DOI: 10.1186/1749-7922-7-3] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2011] [Accepted: 01/23/2012] [Indexed: 12/03/2022] Open
Affiliation(s)
- Salomone Di Saverio
- Maggiore Hospital - Bologna Local Health District Trauma Surgery Unit (Head Dr, G, Tugnoli) Department of Emergency, Department of Surgery L,go Nigrisoli, ZIP 40123, Bologna, Italy.
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Xu C, Dai M, You F, Shi X, Fu F, Liu R, Dong X. An optimized strategy for real-time hemorrhage monitoring with electrical impedance tomography. Physiol Meas 2011; 32:585-98. [PMID: 21478567 DOI: 10.1088/0967-3334/32/5/007] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
Delayed detection of an internal hemorrhage may result in serious disabilities and possibly death for a patient. Currently, there are no portable medical imaging instruments that are suitable for long-term monitoring of patients at risk of internal hemorrhage. Electrical impedance tomography (EIT) has the potential to monitor patients continuously as a novel functional image modality and instantly detect the occurrence of an internal hemorrhage. However, the low spatial resolution and high sensitivity to noise of this technique have limited its application in clinics. In addition, due to the circular boundary display mode used in current EIT images, it is difficult for clinicians to identify precisely which organ is bleeding using this technique. The aim of this study was to propose an optimized strategy for EIT reconstruction to promote the use of EIT for clinical studies, which mainly includes the use of anatomically accurate boundary shapes, rapid selection of optimal regularization parameters and image fusion of EIT and computed tomography images. The method was evaluated on retroperitoneal and intraperitoneal bleeding piglet data. Both traditional backprojection images and optimized images among different boundary shapes were reconstructed and compared. The experimental results demonstrated that EIT images with precise anatomical information can be reconstructed in which the image resolution and resistance to noise can be improved effectively.
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Affiliation(s)
- Canhua Xu
- Department of Biomedical Engineering, Fourth Military Medical University, Xi'an 710032, People's Republic of China
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Sutherland I, Ledder O, Crameri J, Nydegger A, Catto-Smith A, Cain T, Oliver M. Pancreatic trauma in children. Pediatr Surg Int 2010; 26:1201-6. [PMID: 20803148 DOI: 10.1007/s00383-010-2705-3] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/12/2010] [Indexed: 12/11/2022]
Abstract
PURPOSE To document the demographics, mechanisms and outcome of traumatic pancreatitis in children at a single large tertiary referral centre in Australia. METHODS We undertook a 10-year retrospective audit of children admitted to the Royal Children's Hospital, Melbourne, Australia with a hospital coded diagnosis which included pancreatic injury between 1993 and 2002. Data included patient demographics, source of admission, mechanism of injury, pancreatic complications, associated injuries, intensive care unit admission, results of any operative findings, results of any acute computed tomography and/or ultrasound imaging of pancreas, selected laboratory findings and length of stay. RESULTS We identified two distinct groups of patients in the 91 documented cases of pancreatic trauma (median age 8.0 years, range 0.6-15.8 years; M:F 2.5:1.0): 59 had a history of abdominal trauma and elevated serum lipase but no CT or ultrasound evidence of pancreatic injury (Group A); 32 had a history of abdominal trauma, elevated serum lipase but also had CT scan and/or ultrasound evidence of pancreatic injury (Group B). Patients with "less severe" injury based on normal imaging had a lower initial lipase level [Group A, median 651 U/L (interquartile range 520-1,324) vs. Group B, 1,608 U/L (interquartile range 680-3,526); p = 0.005] and shorter admission time [Group A, 9.0 days (interquartile range 5.5-15.5) vs. Group B, 13.4 days (interquartile range 6.8-23.8); p = 0.04]. There were no differences with respect to mortality (Group A, 13.5% vs. Group B, 12.5%), but patients with evidence of injury on imaging were more likely to have surgical intervention (p = 0.0001). The single most important overall cause of pancreatic trauma was involvement in a motor vehicle accident as a passenger or pedestrian. However, in children with high-grade ductal injury, bicycle handlebar injuries were most common. Associated injuries were common in both groups. CONCLUSION Significant pancreatic injury can occur in the absence of abnormality on medical imaging. Pancreatic trauma commonly occurs in the context of multiple injuries after motor vehicle accidents in children and bicycle handlebar injuries, especially in boys. Most children can be treated conservatively, with surgical intervention being limited to high-grade ductal injury.
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Affiliation(s)
- Ingrid Sutherland
- Department of Gastroenterology and Clinical Nutrition, Royal Children's Hospital, Melbourne, Australia
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Abstract
Management of blunt liver trauma has progressed over the last 20 years with the adoption of conservative non-operative management (CM) as the gold standard in 80-90% of patients. Clinical and hemodynamic changes, and CT imaging guide the conservative attitude or pose an indication for urgent surgical intervention in unstable patients. The adoption of CM for blunt liver trauma has resulted in an increased incidence of late complications. These consist principally of persistent hemorrhage, fistulas and bile leaks, the abdominal compartment syndrome, and hepatic necrosis or abscess. These late complications can be managed secondarily by planned interventions via laparotomy or laparoscopy, interventional radiology and/or endoscopic techniques in a non-emergency setting as indicated by circumstances and with the benefit of multidisciplinary consultation. These secondary interventions should not be considered a failure of conservative treatment, but rather as an anticipated eventuality in the management of these patients.
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Affiliation(s)
- A-F Bouras
- Service de chirurgie digestive et transplantations, hôpital Claude-Huriez, CHRU de Lille, rue, Michel-Polonovski, 59037 Lille cedex, France.
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Abstract
The nonoperative care of intraabdominal trauma in the polytraumatised patient greatly depends on imaging techniques. The haemodynamically unstable patient should undergo expedient sonography to rule out abdominal haemorrhage. The use of computer tomography (CT) in this difficult patient group is also currently evaluated, however it takes specific amendments to the protocol and institution. In the hemodynamically stable patient however, computer tomography is the modality of choice to evaluate the injured abdomen. Nonoperative treatment can be successful in up to 80% of selected cases. Adjuncts to nonoperative care include embolisation of the spleen and liver in cases of arterial bleeding, and endoscopic retrograde cholangio pancreaticography (ERCP) and stenting for injuries to the biliary tree.
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Affiliation(s)
- Luke P H Leenen
- Department of Surgery, University Medical Centre, Utrecht, The Netherlands.
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Shuai W, You F, Zhang H, Zhang W, Fu F, Shi X, Liu R, Bao T, Dong X. Application of Electrical Impedance Tomography for Continuous Monitoring of Retroperitoneal Bleeding After Blunt Trauma. Ann Biomed Eng 2009; 37:2373-9. [DOI: 10.1007/s10439-009-9778-y] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2009] [Accepted: 08/03/2009] [Indexed: 10/20/2022]
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You F, Shuai W, Shi X, Fu F, Liu R, Dong X. Monitoring retroperitoneal bleeding model of piglets by electrical impedance tomography. ANNUAL INTERNATIONAL CONFERENCE OF THE IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. ANNUAL INTERNATIONAL CONFERENCE 2009; 2008:1185-7. [PMID: 19162877 DOI: 10.1109/iembs.2008.4649374] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
To investigate continuous monitoring capacity of electrical impedance tomography (EIT) for retroperitoneal bleeding, studies were carried out on six anesthetized piglet's bleeding model produced by injecting anticoagulated blood into renal region. For each subject, total blood of about 200 ml was injected within time periods ranging from tens of minutes to several hours. The simulated bleeding processes were detected and monitored by EIT system with sixteen electrodes at a rate of one image per second. EIT images were reconstructed by dynamic back-projection algorithm. The results showed that impedance changes caused by bleeding could be revealed by EIT images.
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Affiliation(s)
- Fusheng You
- Department of Biomedical Engineering, Fourth Military Medical University, Xi'an 710032, China.
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Fang GE, Luo TH, DU CH, Bi JW, Xue XC, Wei G, Weng ZZ, Ma LY, Hua JD. Clinical management of abdominal trauma. Chin J Traumatol 2008; 11:239-42. [PMID: 18667122 DOI: 10.1016/s1008-1275(08)60049-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023] Open
Abstract
OBJECTIVE To improve the prognosis of patients with abdominal trauma. METHODS Between January 1993 and December 2005, 415 patients were enrolled in this research. The patients consisted of 347 males and 68 females with mean age of 36 years (ranging from 3-82 years). All abdominal traumas consisted of closed traumas (360 cases, 86.7%) and open traumas (55 cases, 13.3%). RESULTS A total of 407 cases (98.1%) were fully recovered from trauma and the other 8 cases (1.9%) died of multiple injuries. The mean injury severity score (ISS) of all patients was 22 while the mean ISS of the patients who died in hospital was 42. Postoperative complications were seen in 9 patients such as infection of incisional wounds (6 cases), pancreatic fistula (2 cases) and intestinal fistula (1 case). All these postoperative complications were cured by the conservative treatment. CONCLUSION Careful case history inquisition and physical examination are the basic methods to diagnose abdominal trauma. Focused abdominal ultrasonography is always the initial imaging examination because it is non-invasive and can be performed repeatedly with high accuracy. The doctors should consider the severity of local injuries and the general status of patients during the assessment of abdominal trauma. The principle of treatment is to save lives at first, then to cure the injuries. Unnecessary laparotomy should be avoided to reduce additional surgical trauma.
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Affiliation(s)
- Guo-en Fang
- Department of General Surgery, Changhai Hospital, Second Military Medical University, Shanghai 200433, China.
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[Rare complication of colonoscopy: hemoperitoneum secondary to splenic rupture]. ACTA ACUST UNITED AC 2008; 31:1153-4. [PMID: 18176378 DOI: 10.1016/s0399-8320(07)78356-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
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Abstract
The therapeutic and diagnostic approach of liver trauma injuries (by extension, of abdominal trauma) has evolved remarkably in the last decades. The current non-surgical treatment in the vast majority of liver injuries is supported by the accumulated experience and optimal results in the current series. It is considered that the non-surgical treatment of liver injuries has a current rate of success of 83-100%, with an associated morbidity of 5-42%. The haemodynamic stability of the patient will determine the applicability of the non-surgical treatment. Arteriography with angioembolisation constitutes a key technical tool in the context of liver trauma. Patients with haemodynamic instability will need an urgent operation and can benefit from abdominal packing techniques, damage control and post-operative arteriography. The present review attempts to contribute to the current, global and practical management in the care of liver trauma.
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Affiliation(s)
- Leonardo Silvio-Estaba
- Servicio de Cirugía General y Digestiva, Hospital Universitario de Bellvitge, L'Hospitalet de Llobregat, Barcelona, España.
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Brady RRW, Bandari M, Kerssens JJ, Paterson-Brown S, Parks RW. Splenic Trauma in Scotland: Demographics and Outcomes. World J Surg 2007; 31:2111-6. [PMID: 17849160 DOI: 10.1007/s00268-007-9218-9] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
BACKGROUND Splenic trauma is a common organ injury following blunt abdominal trauma. In order to establish the contemporary epidemiology of blunt splenic trauma in Scotland and to detect risk factors associated with patient outcomes, analysis of a multi-center database of trauma patients was performed. METHODS The study used data from a prospectively collated multicenter trauma database containing the details of 52,215 trauma patients admitted to participating Scottish hospitals over an 11-year period. RESULTS 672 (1.3%) patients (530 males, 142 females) with splenic trauma were identified; of them, 579 (86.2%) had blunt trauma and 93 (13.8%) had penetrating trauma. The mean age of patients with blunt splenic trauma was 35.7 years (33.8 years for males, 42.0 years for females). Increasing age and female sex was significantly associated with mortality. The most common mechanism for injury was road traffic accidents (71%). In the series, 93.8% of patients had concomitant injuries including head injuries (46.5%), thoracic injuries (37.7%) and liver injuries (30%). A total of 299 (51.6%) patients proceeded to laparotomy, and 256 (44.2%) patients required ICU support. The overall mortality was 33.5%, and the median Injury Severity Score was 48 in patients who died, compared to 22 in those who survived. Increased mortality was associated with concomitant aortic, cardiac, or abdominal injuries. A number of independent risk factors were associated with increased risk of mortality, including concomitant injuries, increased age, and increased Injury Severity Score. CONCLUSIONS The incidence of splenic trauma is low, but it accounts for significant mortality. Outcome in the present study was worse in those with advanced age and associated injuries.
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Affiliation(s)
- Richard R W Brady
- Academic Coloproctology, 4th Floor MRC Human Genetics Unit, Western General Hospital, Crewe Road, Edinburgh, Scotland EH4 2XU.
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Franklin GA, Richardson JD, Brown AL, Christmas AB, Miller FB, Harbrecht BG, Carrillo EH. Prevention of Bile Peritonitis by Laparoscopic Evacuation and Lavage after Nonoperative Treatment of Liver Injuries. Am Surg 2007. [DOI: 10.1177/000313480707300614] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
One of the major lessons learned in the World War II experience with liver injuries was that bile peritonitis was a major factor in morbidity and mortality; the nearly uniform drainage of liver injuries in the subsequent operative era prevented this problem. In the era of nonoperative management, patients who do not require operative treatment for hemodynamic instability may develop large bile and/or blood collections that are often ignored or inadequately drained by percutaneous methods. These inadequately treated bile collections may cause systemic inflammatory response syndrome and/or respiratory distress. We present an experience with laparoscopic evacuation of major bile/blood collections that may prevent the inflammatory sequelae of bile peritonitis. Patients usually underwent operation between 3 and 5 days postinjury (range, 2–18) if CT demonstrated large fluid collections throughout the abdomen/pelvis not amenable to percutaneous drainage. Most patients had signs of systemic inflammatory response syndrome, respiratory compromise, or elevated bilirubin. The bile and retained hematoma was evacuated from around the liver and closed-suction drainage was placed. Twenty-eight patients underwent laparoscopic evacuation/lavage of bile collections (about 4% of total blunt liver injuries). The majority (75%) had Grade IV or V injury. The amount of evacuated fluid ranged from 300 to 3800 mL. Other adjunctive procedures (endoscopic retrograde pancreaticocholangiography, angiography, and laparotomy) were occasionally required. There were no complications related to the procedure. Most patients had a dramatic decline in tachycardia, temperature, white blood cell count, serum bilirubin, and pain. Respiratory failure also resolved in most patients. Large bile and/or blood accumulations are present in a subset of patients with severe liver injuries treated nonoperatively. Delayed laparoscopic evacuation of these collections prevents bile peritonitis and decreases inflammatory response and avoiding early operation, which has been implicated in increased death from hemorrhage.
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Affiliation(s)
- Glen A. Franklin
- Department of Surgery, University of Louisville, Louisville, Kentucky and
| | | | - Aaron L. Brown
- Department of Surgery, University of Louisville, Louisville, Kentucky and
| | | | - Frank B. Miller
- Department of Surgery, University of Louisville, Louisville, Kentucky and
| | - Brian G. Harbrecht
- Department of Surgery, University of Louisville, Louisville, Kentucky and
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