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Fujita M, Sato T, Takase K, Sato T, Furukawa H, Kushimoto S. Hepatic compartment syndrome treated with damage control surgery and transarterial embolization: A case report. Trauma Case Rep 2023; 46:100857. [PMID: 37292437 PMCID: PMC10245332 DOI: 10.1016/j.tcr.2023.100857] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/27/2023] [Indexed: 06/10/2023] Open
Abstract
Background Hepatic compartment syndrome (HCS) is a complication of nonoperative management in patients with blunt hepatic injury. Although decompression of elevated intrahepatic pressure through surgical exploration or drainage and hemorrhage control are required to manage this condition, evidence for such a management for this complication is insufficient. Herein, we report a pediatric patient treated with a planned combination strategy of surgical decompression with perihepatic packing to reduce intrahepatic pressure and subcapsular hemorrhage control as well as angioembolization to control intraparenchymal hemorrhage. Case presentation A 12-year-old boy was referred to our emergency department 5 h after sustaining severe bruising in the upper abdomen in a traffic accident. Computed tomography (CT) showed an intraparenchymal hematoma in the right lobe of the liver; nonoperative management was selected based on stable hemodynamic status. Two days after the injury, he complained of severe abdominal pain and shock. CT showed an intraparenchymal and large subcapsular hematoma with right branch compression of the portal vein and extravasation of contrast material. Laboratory data showed progression of hepatocellular damage. We successfully managed this patient with a planned combination strategy of surgical decompression with perihepatic packing for reduction of intrahepatic pressure and subcapsular hemorrhage control, followed by angioembolization for control of intraparenchymal hemorrhage. Conclusion Our study suggests that for the management of HCS, a planned combination strategy of damage control surgery and angioembolization is a therapeutic option.
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Affiliation(s)
- Motoo Fujita
- Department of Emergency and Critical Care Medicine, Tohoku University Hospital Emergency Center, Sendai-shi 980-8574, Japan
| | - Takeaki Sato
- Department of Emergency and Critical Care Medicine, Tohoku University Hospital Emergency Center, Sendai-shi 980-8574, Japan
| | - Kei Takase
- Department of Diagnostic Radiology, Tohoku University Hospital, Sendai-shi 980-8574, Japan
| | - Tomomi Sato
- Department of Diagnostic Radiology, Tohoku University Hospital, Sendai-shi 980-8574, Japan
| | - Hajime Furukawa
- Department of Emergency and Critical Care Medicine, Tohoku University Hospital Emergency Center, Sendai-shi 980-8574, Japan
| | - Shigeki Kushimoto
- Department of Emergency and Critical Care Medicine, Tohoku University Hospital Emergency Center, Sendai-shi 980-8574, Japan
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2
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Chu M, How N, Laviolette A, Bilic M, Tang J, Khalid M, Bos C, Rice TJ, Engels PT. Delayed laparoscopic peritoneal washout in non-operative management of blunt abdominal trauma: a scoping review. World J Emerg Surg 2022; 17:37. [PMID: 35780121 PMCID: PMC9250192 DOI: 10.1186/s13017-022-00441-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2022] [Accepted: 06/26/2022] [Indexed: 11/10/2022] Open
Abstract
OBJECTIVES Non-operative management (NOM) of blunt abdominal trauma has become increasingly common in hemodynamically stable patients. There are known complications of NOM from undrained intra-abdominal fluid accumulations including hemorrhage and peritonitis that require delayed operation. Thus, delayed operation can be considered as part of the overall management plan, instead of failure, of NOM. The aim of this scoping review is to establish key concepts regarding delayed laparoscopic peritoneal washout (DLPW) following NOM of blunt abdominal trauma patients. METHODS MEDLINE, EMBASE, CENTRAL, and gray literature were systematically searched. Studies were included if they investigated or reported on the use of delayed laparoscopy involving peritoneal washout following NOM of blunt abdominal trauma patients. Bibliographies of included studies were manually reviewed to identify additional articles for inclusion. RESULTS From 910 citations, 28 studies met inclusion criteria. This included seven case reports, eleven case series or observational cohort studies, six review articles, two management guidelines, one textbook chapter, and one randomized clinical trial. For those reported, medium grade liver injuries proved most common (95.2%). Indications for DLPW were primarily clinical features and changes in imaging findings, highlighting the importance of close observation. Authors reported clinical improvement after DLPW regarding symptomatology, vital signs, and biochemistry. A relatively high transfusion demand was reported with a mean of four units of packed red blood cells pre-operatively. Length of stay and post-operative complications were consistent with previously reported experiences with blunt abdominal injuries. CONCLUSIONS DLPW is beneficial in blunt abdominal trauma patients following NOM with improvement in symptoms, SIRS features, and a possible reduction in hospital length of stay. This study is limited by low-quality evidence and skewing of data toward isolated hepatic injuries. Future prospective cohort study comparing NOM with and without DLPW is required.
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Affiliation(s)
- Megan Chu
- Division of General Surgery, McMaster University, Hamilton, Canada.
| | - Nathan How
- Division of General Surgery, McMaster University, Hamilton, Canada
| | - Alysha Laviolette
- Michael G. DeGroote School of Medicine, McMaster University, Hamilton, Canada
| | - Monika Bilic
- Michael G. DeGroote School of Medicine, McMaster University, Hamilton, Canada
| | - Jennifer Tang
- Temerty Faculty of Medicine, University of Toronto, Toronto, Canada
| | - Maham Khalid
- Michael G. DeGroote School of Medicine, McMaster University, Hamilton, Canada
| | - Cecily Bos
- Division of General Surgery, McMaster University, Hamilton, Canada.,Trauma Program, Hamilton General Hospital, Hamilton Health Sciences, Hamilton, Canada
| | - Timothy J Rice
- Division of General Surgery, McMaster University, Hamilton, Canada.,Trauma Program, Sunnybrook Health Sciences Centre, Toronto, Canada
| | - Paul T Engels
- Division of General Surgery, McMaster University, Hamilton, Canada.,Trauma Program, Sunnybrook Health Sciences Centre, Toronto, Canada
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3
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The role of interventional radiology in the management of refractory bile leaks. Abdom Radiol (NY) 2022; 47:1881-1890. [PMID: 33733336 DOI: 10.1007/s00261-021-03016-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2020] [Revised: 02/17/2021] [Accepted: 02/25/2021] [Indexed: 10/21/2022]
Abstract
Refractory bile leaks represent a damaging sequela of hepatobiliary surgery and direct trauma. Management of bile leaks represents a challenging clinical problem. Despite advances in endoscopic techniques, interventional radiology continues to play a vital role in the diagnosis and management of refractory bile leaks. This article reviews strategies for optimizing the diagnosis and management of bile leaks and provides an overview of management strategies, including the management of complicated biliary leaks.
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4
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Jones ME, Ban EJ, Pilgrim CHC. An Unusual Recurrent Bile Leak Following High Grade Liver Trauma. JOURNAL OF ACUTE CARE SURGERY 2021. [DOI: 10.17479/jacs.2021.11.3.137] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
Non-operative management of blunt liver injury has been demonstrated as a safe and effective treatment for most grades of injury. As the severity of liver injury increases, so does the risk of complications. A 21-year-old male was brought to the trauma center following a high speed motorbike accident. He underwent a laparotomy and angioembolization for a Grade 4 liver injury. A biloma was diagnosed on Day 18 post injury, and he underwent Endoscopic Retrograde Cholangiopancreatography and biliary stenting which were unsuccessful. There were 2 re-admissions for infected perihepatic collections. In this case, an Endoscopic Retrograde Cholangiopancreatography was not a helpful procedure due to a disconnected liver segment, and morbidity occurred due to instrumentation of the biliary tree (the likely cause of infected biloma). Hepatic resection should be considered for patients who fail non-operative management. Further assessment of efficacy using a larger dataset for analysis is required.
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5
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Wolf R, Smolinski-Zhao S. Delayed and Chronic Sequelae of Trauma and the Role of the Interventional Radiologist. Semin Intervent Radiol 2021; 38:131-138. [PMID: 33883810 DOI: 10.1055/s-0041-1726003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
In addition to acute injury requiring interventional radiologic treatments, patients with traumatic injuries can develop delayed or chronic complications. These injuries can involve nearly all solid organs in the abdomen. Coupled with significant improvements in visualizing these injuries with advanced imaging techniques such as minimally invasive procedures, nonoperative management of both acute traumatic injuries and their longer term sequelae has become the norm. This article reviews frequently seen complications of traumatic injury and their management by interventional radiologists.
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Affiliation(s)
- Robert Wolf
- Department of Radiology, Massachusetts General Hospital, Boston, Massachusetts.,Boston University School of Medicine, Boston, Massachusetts
| | - Sara Smolinski-Zhao
- Department of Radiology, Massachusetts General Hospital, Boston, Massachusetts
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6
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The Role of Angioembolization in Liver Trauma: the 10-Year Retrospective Experience of a Level One Trauma Center. Indian J Surg 2021. [DOI: 10.1007/s12262-021-02726-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022] Open
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7
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Ban EJ, Hii B, Smith M, Clements W. Early surgical management of severe liver trauma with vascular complication can lead to early discharge. TRAUMA-ENGLAND 2020. [DOI: 10.1177/1460408620911492] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Intrahepatic arterio-portal fistulas are rare complications of blunt hepatic trauma. We describe a case of a 35-year-old male sustaining blunt abdominal trauma resulting in a grade IV liver injury complicated by arterio-portal fistula, portal venous pseudoaneurysm and concomitant bile duct injury. Although arterial embolisation is the mainstay of treatment for arterio-portal fistula, we describe a rationale for early involvement of a hepatobiliary surgeon for multidisciplinary management. Hepatic resection for acute hepatic trauma can, in selected cases, promptly manage all elements of portal triad injury, and in this particular case facilitated early uncomplicated discharge.
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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; 71:352-361. [PMID: 32166970 DOI: 10.1177/0846537120908069] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
This review aims to examine the challenges facing radiologists interpreting trauma computed tomography (CT) images in this era of a changing approach to management of solid organ trauma. After reviewing the pearls and pitfalls of CT imaging protocols for detection of traumatic solid organ injuries, we describe the key changes in the 2018 American Association for the Surgery of Trauma Organ Injury Scales for liver, spleen, and kidney and their implications for management strategies. We then focus on the important imaging findings in observed in patients who undergo nonoperative management and patients who are imaged post damage control surgery.
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Affiliation(s)
- Siobhán B O'Neill
- Department of Emergency Radiology, University of British Columbia, Vancouver General Hospital, Vancouver, British Columbia, Canada
| | - Saira Hamid
- Department of Emergency Radiology, University of British Columbia, Vancouver General Hospital, Vancouver, British Columbia, Canada
| | - Savvas Nicolaou
- Department of Emergency Radiology, University of British Columbia, Vancouver General Hospital, Vancouver, British Columbia, Canada
| | - Sadia R Qamar
- Department of Emergency Radiology, University of British Columbia, Vancouver General Hospital, Vancouver, British Columbia, Canada
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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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Grigorian A, Joe V, Delaplain PT, Schubl S, Barker B, Gabriel V, Dosch AR, Barrios C, Nahmias J. Risk of hysterectomy and salpingectomy or oophorectomy compared to repair after pelvic gynecologic trauma. Eur J Trauma Emerg Surg 2018; 45:403-410. [PMID: 29511771 DOI: 10.1007/s00068-018-0936-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2017] [Accepted: 03/03/2018] [Indexed: 11/30/2022]
Abstract
PURPOSE Pelvic gynecologic trauma (PGT) includes injury to the uterus, ovaries or fallopian tubes. We hypothesized Injury Severity Score (ISS) ≥ 25, hypotension on admission and age ≥ 51 (average age for menopause) would be independent risk factors for resection compared to repair. METHODS A retrospective analysis of the National Trauma Data Bank was performed between 2007 and 2015. RESULTS Of 2,040,235 female patients, 1938 (< 0.1%) presented with PGT with the majority sustaining injury to the ovary or fallopian tubes (52.9%). Most patients were managed nonoperatively (77.1 vs 22.9%). On multivariable analysis, in patients with injury to the uterus, ISS ≥ 25 (OR 3.52, CI 1.67-7.48, p < 0.05) was associated with higher risk for hysterectomy compared to repair. In patients with injury to the ovaries or fallopian tubes, gunshot wound (OR 3.73, CI 1.43-9.68, p < 0.05) was associated with a higher risk for salpingectomy or oophorectomy compared to repair. Age ≥ 51 and hypotension on admission were not independent risk factors for resection in patients with PGT. Operative treatment was associated with a lower risk for mortality in patients with an injury to the uterus (OR 0.27, CI 0.14-0.51, p < 0.001) or ovaries/fallopian tubes (OR 0.37, CI 0.19-0.72, p < 0.001) compared to those managed nonoperatively. CONCLUSION In the largest study reported, PGT occurred in < 0.1% of traumas involving women. Patients with ISS ≥ 25 have higher risk for hysterectomy compared to repair. Gunshot injuries have higher risk for salpingectomy or oophorectomy compared to repair. Hypotension on arrival or age ≥ 51 are not independent risk factors for resection in PGT. Operative management is associated with lower risk of mortality in PGT patients.
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Affiliation(s)
- Areg Grigorian
- Division of Trauma, Burns and Surgical Critical Care, Department of Surgery, University of California, Irvine, 333 The City Blvd West, Suite 1600, Orange, CA, 92868-3298, USA.
| | - Victor Joe
- Division of Trauma, Burns and Surgical Critical Care, Department of Surgery, University of California, Irvine, 333 The City Blvd West, Suite 1600, Orange, CA, 92868-3298, USA
| | - Patrick Thomas Delaplain
- Division of Trauma, Burns and Surgical Critical Care, Department of Surgery, University of California, Irvine, 333 The City Blvd West, Suite 1600, Orange, CA, 92868-3298, USA
| | - Sebastian Schubl
- Division of Trauma, Burns and Surgical Critical Care, Department of Surgery, University of California, Irvine, 333 The City Blvd West, Suite 1600, Orange, CA, 92868-3298, USA
| | - Bel Barker
- Department of Obstetrics and Gynecology, Kaiser-Permanente, Anaheim, CA, USA
| | - Viktor Gabriel
- Division of Trauma, Burns and Surgical Critical Care, Department of Surgery, University of California, Irvine, 333 The City Blvd West, Suite 1600, Orange, CA, 92868-3298, USA
| | - Austin Ronald Dosch
- Division of Trauma, Burns and Surgical Critical Care, Department of Surgery, University of California, Irvine, 333 The City Blvd West, Suite 1600, Orange, CA, 92868-3298, USA
| | - Cristobal Barrios
- Division of Trauma, Burns and Surgical Critical Care, Department of Surgery, University of California, Irvine, 333 The City Blvd West, Suite 1600, Orange, CA, 92868-3298, USA
| | - Jeffry Nahmias
- Division of Trauma, Burns and Surgical Critical Care, Department of Surgery, University of California, Irvine, 333 The City Blvd West, Suite 1600, Orange, CA, 92868-3298, USA
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11
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Tarchouli M, Elabsi M, Njoumi N, Essarghini M, Echarrab M, Chkoff MR. Liver trauma: What current management? Hepatobiliary Pancreat Dis Int 2018; 17:39-44. [PMID: 29428102 DOI: 10.1016/j.hbpd.2018.01.013] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2017] [Accepted: 11/02/2017] [Indexed: 02/05/2023]
Abstract
BACKGROUND The liver is the most commonly damaged organ in abdominal trauma. The management of liver trauma has experienced many changes over the last two decades. Currently there is a trend toward a non-operative treatment warranted by the successful pediatric experience and better results recorded in many trauma centers worldwide. This study aimed to evaluate outcomes of operative and non-operative management of liver trauma in our institution over the last five years. METHODS The patients with a diagnosis of blunt or penetrating liver injuries, admitted and managed in our hospital from January 2012 to December 2016 were retrospectively studied. The patients were divided into 2 groups, operated and non-operated groups, according to the initial management considered appropriate at the time of patient admission. Clinical features and outcomes were analyzed. RESULTS The study involved 83 patients, with a mean age of 33 years and a marked male predominance (85.5%). The most common type of lesions was blunt trauma and the main cause was road traffic accidents. Sixty-eight liver injuries (81.9%) were of low severity (grades I, II, III), while 15 (18.1%) were of high severity (grade IV or greater). Fifty-six patients (67.5%) had multiple injuries. Surgical treatment was performed in 26 (31.3%) patients. Non-operative management was undertaken in 57 cases (68.7%). The morbidity and mortality rates were clearly lower in non-operative patients compared to those in the operated group. CONCLUSIONS Careful non-operative management is an adequate therapeutic strategy for the patients suffering from liver trauma with stable hemodynamics. Patients with complex hepatic trauma and especially those with other organ injuries continue to have significantly higher mortality.
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Affiliation(s)
- Mohamed Tarchouli
- Department of Digestive Surgery, Mohammed V Military Hospital, Faculty of Medicine and Pharmacy, Sidi Mohamed Ben Abdellah University, Fes, Morocco.
| | - Mohamed Elabsi
- Department of Visceral Surgical Emergency, Ibn Sina Hospital, Faculty of Medicine and Pharmacy, Mohammed V University, Rabat, Morocco
| | - Noureddine Njoumi
- Department of Digestive Surgery, Mohammed V Military Hospital, Faculty of Medicine and Pharmacy, Mohammed V University, Rabat, Morocco
| | - Mohamed Essarghini
- Department of Digestive Surgery, Mohammed V Military Hospital, Faculty of Medicine and Pharmacy, Mohammed V University, Rabat, Morocco
| | - Mahjoub Echarrab
- Department of Visceral Surgical Emergency, Ibn Sina Hospital, Faculty of Medicine and Pharmacy, Mohammed V University, Rabat, Morocco
| | - Mohamed Rachid Chkoff
- Department of Visceral Surgical Emergency, Ibn Sina Hospital, Faculty of Medicine and Pharmacy, Mohammed V University, Rabat, Morocco
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12
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Oliveira FMD, Carvalho MVHD, Marchi E, Pinto CAL. The collagen, fibrinogen and thrombin biological adhesive is effective in treating experimental liver injuries. Rev Col Bras Cir 2017; 43:110-6. [PMID: 27275592 DOI: 10.1590/0100-69912016002007] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2015] [Accepted: 03/17/2016] [Indexed: 11/21/2022] Open
Abstract
OBJECTIVE to evaluate the effectiveness of an collagen-based adhesive associated with fibrinogen and thrombin in experimental liver injuries in rats. METHODS we randomly divided 30 Wistar rats into three groups: A, B and C. All underwent a standard liver traumatic injury. In group A, the lesion was treated with the adhesive; in group B, with conventional, absorbable suture; group C received no treatment. We analyzed the time of hemostasis, mortality, occurrence of adhesions and any histological changes. RESULTS there was no statistical difference in relation to mortality (p=0.5820). The adhesive treated group showed the lowest hemostasis times (p=0.0573, odds ratio 13.5) and lower incidence of adhesions (p=0.0119). The histological alterations of the Groups A and B were similar, with foreign body granuloma formation separating the adhesive material and the hepatic stroma suture. CONCLUSION the collagen adhesive associated with fibrinogen and thrombin was effective in treating experimental hepatic injury, providing a lower incidence of adhesions between the liver and surrounding structures. OBJETIVO avaliar a eficácia de um adesivo a base de colágeno associado ao fibrinogênio e trombina, no trauma hepático experimental em ratos. MÉTODOS toram incluídos no estudo 30 ratos Wistar, igualmente divididos aleatoriamente em três grupos: A, B e C. Todos foram submetidos à lesão traumática hepática padronizada. No grupo A, a lesão foi tratada com o adesivo, no grupo B, com sutura convencional com fio absorvível, e no grupo C, não houve tratamento da lesão. Foram analisados o tempo de hemostasia, mortalidade, ocorrência de aderências e eventuais alterações histológicas. RESULTADOS os resultados mostraram que não houve diferença estatística em relação à mortalidade (p=0,5820). O grupo tratado com adesivo apresentou os menores tempos de hemostasia (p=0,0573 e odds ratio 13,5) e menor ocorrência de aderências (p=0,0119). Microscopicamente as alterações histológicas dos grupos A e B foram semelhantes, com a formação de granuloma de corpo estranho separando o material do adesivo e do fio de sutura do estroma hepático. CONCLUSÃO o adesivo de colágeno associado ao fibrinogênio e trombina foi eficaz no tratamento do trauma hepático experimental, proporcionado menor ocorrência de aderências entre o fígado e as estruturas vizinhas.
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Affiliation(s)
- Frederico Michelino de Oliveira
- Departamento de Cirurgia, Faculdade de Medicina de Jundiaí - FMJ, Jundiaí-SP, Brasil, Faculdade de Medicina de Jundiaí, Departamento de Cirurgia, Faculdade de Medicina de Jundiaí, Jundiaí SP , Brazil
| | - Marcus Vinícius H de Carvalho
- Departamento de Cirurgia, Faculdade de Medicina de Jundiaí - FMJ, Jundiaí-SP, Brasil, Faculdade de Medicina de Jundiaí, Departamento de Cirurgia, Faculdade de Medicina de Jundiaí, Jundiaí SP , Brazil
| | - Evaldo Marchi
- Departamento de Cirurgia, Faculdade de Medicina de Jundiaí - FMJ, Jundiaí-SP, Brasil, Faculdade de Medicina de Jundiaí, Departamento de Cirurgia, Faculdade de Medicina de Jundiaí, Jundiaí SP , Brazil
| | - Clóvis Antônio Lopes Pinto
- Departamento de Morfologia e Patologia Básica, Faculdade de Medicina de Jundiaí - FMJ, Jundiaí-SP, Brasil, Faculdade de Medicina de Jundiaí, Departamento de Morfologia e Patologia Básica, Faculdade de Medicina de Jundiaí, Jundiaí SP , Brazil
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13
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Fu CJ, Wong YC, Tsang YM, Wang LJ, Chen HW, Ku YK, Wu CH, Chen HW, Kang SC. Computed tomography arterial portography for assessment of portal vein injury after blunt hepatic trauma. Diagn Interv Radiol 2016; 21:361-7. [PMID: 26268303 DOI: 10.5152/dir.2015.14445] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
PURPOSE Intrahepatic portal vein injuries secondary to blunt abdominal trauma are difficult to diagnose and can result in insidious bleeding. We aimed to compare computed tomography arterial portography (CTAP), reperfusion CTAP (rCTAP), and conventional computed tomography (CT) for diagnosing portal vein injuries after blunt hepatic trauma. METHODS Patients with blunt hepatic trauma, who were eligible for nonoperative management, underwent CTAP, rCTAP, and CT. The number and size of perfusion defects observed using the three methods were compared. RESULTS A total of 13 patients (seven males/six females) with a mean age of 34.5±14.1 years were included in the study. A total of 36 hepatic segments had perfusion defects on rCTAP and CT, while there were 47 hepatic segments with perfusion defects on CTAP. The size of perfusion defects on CT (239 cm3; interquartile range [IQR]: 129.5, 309.5) and rCTAP (238 cm3; IQR: 129.5, 310.5) were significantly smaller compared with CTAP (291 cm3; IQR: 136, 371) (both, P = 0.002). CONCLUSION Perfusion defects measured by CTAP were significantly greater than those determined by either rCTAP or CT in cases of blunt hepatic trauma. This finding suggests that CTAP is superior to rCTAP and CT in evaluating portal vein injuries after blunt liver trauma.
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Affiliation(s)
- Chen Ju Fu
- Division of Emergency and Critical Care Radiology, Department of Medical Imaging and Intervention, Chang Gung Memorial Hospital, Chang Gung University College of Medicine, TaoYuan, Taiwan.
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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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OLIVEIRA FREDERICOMICHELINODE, CARVALHO MARCUSVINÍCIUSHDE, MARCHI EVALDO, PINTO CLÓVISANTÔNIOLOPES. Collagen, fibrinogen and thrombin biological addesive is effective in treating experimental liver injuries. Rev Col Bras Cir 2016; 43:254-61. [DOI: 10.1590/0100-69912016004004] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2016] [Accepted: 06/26/2016] [Indexed: 11/22/2022] Open
Abstract
ABSTRACT Objective : to evaluate the effectiveness of a collagen-based adhesive associated with fibrinogen and thrombin in experimental liver injury in rats. Methods : the study included 30 Wistar rats randomly divided into three groups: A, B and C. All underwent standard liver traumatic injury. In group A the lesion was treated with the adhesive; in group B, with conventional absorbable suture; and in group C, there was no treatment. We analyzed the time of hemostasis, mortality, occurrence of adhesions and any histological changes. Results : there was no statistical difference in relation to mortality (p = 0.5820). The group treated with the adhesive showed the lowest hemostasis times (p = 0.0573, odds ratio 13.5) and lower incidence of adhesions (p = 0.0119). Microscopic histological alterations of Groups A and B were similar, with foreign body granuloma formation separating the adhesive material or the suture from the hepatic stroma. Conclusion : the adhesive of collagen associated with fibrinogen and thrombin was effective in the treatment of experimental hepatic injury, providing a lower incidence of adhesions between the liver and surrounding structures.
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Thony F, Rodière M, Frandon J, Vendrell A, Jankowski A, Ghelfi J, Sengel C, Arvieux C, Bouzat P, Ferretti G. Polytraumatism and solid organ bleeding syndrome: The role of imaging. Diagn Interv Imaging 2015. [PMID: 26206744 DOI: 10.1016/j.diii.2015.06.004] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
In multiple injuries, features of bleeding from solid organs mostly involve the liver, spleen and kidneys and may be treated by embolization. The indications and techniques for embolization vary between organs and depend on the pathophysiology of the injuries, type of vascularization (anastomotic or terminal) and type of embolization (curative or preventative). Interventional radiologists should have a full understanding of these indications and techniques and management algorithms should be produced within each facility in order to define the respective place of the different treatment options.
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Affiliation(s)
- F Thony
- Radiology and Medical Imaging University Clinic, Grenoble University Hospitals, Grenoble, France.
| | - M Rodière
- Radiology and Medical Imaging University Clinic, Grenoble University Hospitals, Grenoble, France
| | - J Frandon
- Radiology and Medical Imaging University Clinic, Grenoble University Hospitals, Grenoble, France
| | - A Vendrell
- Radiology and Medical Imaging University Clinic, Grenoble University Hospitals, Grenoble, France
| | - A Jankowski
- Radiology and Medical Imaging University Clinic, Grenoble University Hospitals, Grenoble, France
| | - J Ghelfi
- Radiology and Medical Imaging University Clinic, Grenoble University Hospitals, Grenoble, France
| | - C Sengel
- Radiology and Medical Imaging University Clinic, Grenoble University Hospitals, Grenoble, France
| | - C Arvieux
- Gastrointestinal and Emergency Surgery University Clinic, Grenoble University Hospitals, Grenoble, France
| | - P Bouzat
- Anesthesia Intensive Care Unit, Grenoble University Hospitals, Grenoble, France
| | - G Ferretti
- Radiology and Medical Imaging University Clinic, Grenoble University Hospitals, Grenoble, France
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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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Smoliar AN, Dzhagraev KR. [One-stage surgical treatment of severe closed combined liver trauma]. Khirurgiia (Mosk) 2015:79-81. [PMID: 26031825 DOI: 10.17116/hirurgia2015279-81] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Affiliation(s)
- A N Smoliar
- Otdelenie ostrykh khirurgicheskikh zabolevaniĭ pecheni i podzheludochnoĭ zhelezy Nauchno-issledovatel'skogo instituta skoroĭ pomoshchi im. N.V. Sklifosovskogo, Moskva
| | - K R Dzhagraev
- Otdelenie ostrykh khirurgicheskikh zabolevaniĭ pecheni i podzheludochnoĭ zhelezy Nauchno-issledovatel'skogo instituta skoroĭ pomoshchi im. N.V. Sklifosovskogo, Moskva
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Raza M, Abbas Y, Devi V, Prasad KVS, Rizk KN, Nair PP. Non operative management of abdominal trauma - a 10 years review. World J Emerg Surg 2013; 8:14. [PMID: 23561288 PMCID: PMC3636075 DOI: 10.1186/1749-7922-8-14] [Citation(s) in RCA: 80] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2013] [Accepted: 03/26/2013] [Indexed: 11/29/2022] Open
Abstract
INTRODUCTION Due to high rate of operative mortality and morbidity non-operative management of blunt liver and spleen trauma was widely accepted in stable pediatric patients, but the general surgeons were skeptical to adopt it for adults. The current study is analysis of so far largest sample (1071) of hemodynamically stable blunt liver, spleen, kidney and pancreatic trauma patients managed non operatively irrespective of severity of a single /multiple solid organ injury or other associated injuries with high rate of success. METHODS Experience of 1071 blunt abdominal trauma patients treated by NOM at a tertiary care National Trauma Centre in Oman (from Jan 2001 to Dec 2011) was reviewed, analyzed to determine the indications, methods and results of NOM. Hemodynamic stability along with ultra sound, CT scan and repeated clinical examination were the sheet anchors of NOM. The patients were grouped as (1) managed by NOM successfully, (2) failure of NOM and (3) directly subjected to surgery. RESULTS During the 10 year period, 5400 polytrauma patients were evaluated for abdominal trauma of which 1285 had abdominal injuries, the largest sample study till date. Based on initial findings 1071 patients were admitted for NOM. Out of 1071 patients initially selected 963 (89.91%) were managed non operatively, the remaining 108 (10.08%) were subjected to laparotomy due to failure of NOM. Laparotomy was performed on 214(19.98%) patients as they were unstable on admission or had evidence of hollow viscous injury. CONCLUSION NOM for blunt abdominal injuries was found to be highly successful in 89.98% of the patients in our study. Management depended on clinical and hemodynamic stability of the patient. A patient under NOM should be admitted to intensive care / high dependency for at least 48-72 hours for close monitoring of vital signs, repeated clinical examinations and follow up investigations as indicated.
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Affiliation(s)
- Mohsin Raza
- Surgery Department, Khoula Hospital, Muscat, Sultanate of Oman
- 4/894, AikMinar Enclave, Near ShaukatManzil, Dodhpur, Aligarh, UP 202002, India
| | - Yasser Abbas
- Surgery Department, Khoula Hospital, Muscat, Sultanate of Oman
| | - Vanitha Devi
- Surgery Department, Khoula Hospital, Muscat, Sultanate of Oman
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Wei J, Feng J. Laparoscopic treatment of liver diseases in children. Front Med 2011; 5:388-94. [PMID: 22198750 DOI: 10.1007/s11684-011-0165-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2011] [Accepted: 10/12/2011] [Indexed: 02/06/2023]
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