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Aryan N, Grigorian A, Tay-Lasso E, Cripps M, Carmichael H, McIntyre R, Urban S, Velopulos C, Cothren Burlew C, Ballow S, Dirks RC, LaRiccia A, Farrell MS, Stein DM, Truitt MS, Grossman Verner HM, Mentzer CJ, Mack TJ, Ball CG, Mukherjee K, Mladenov G, Haase DJ, Abdou H, Schroeppel TJ, Rodriquez J, Bala M, Keric N, Crigger M, Dhillon NK, Ley EJ, Egodage T, Williamson J, Cardenas TC, Eugene V, Patel K, Costello K, Bonne S, Elgammal FS, Dorlac W, Pederson C, Werner NL, Haan JM, Lightwine K, Semon G, Spoor K, Harmon LA, Samuels JM, Spalding MC, Nahmias J. High-grade liver injuries with contrast extravasation managed initially with interventional radiology versus observation: A secondary analysis of a WTA multicenter study. Am J Surg 2024; 234:105-111. [PMID: 38553335 DOI: 10.1016/j.amjsurg.2024.03.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2024] [Revised: 03/15/2024] [Accepted: 03/19/2024] [Indexed: 07/06/2024]
Abstract
BACKGROUND High-grade liver injuries with extravasation (HGLI + Extrav) are associated with morbidity/mortality. For low-grade injuries, an observation (OBS) first-strategy is beneficial over initial angiography (IR), however, it is unclear if OBS is safe for HGLI + Extrav. Therefore, we evaluated the management of HGLI + Extrav patients, hypothesizing IR patients will have decreased rates of operation and mortality. METHODS HGLI + Extrav patients managed with initial OBS or IR were included. The primary outcome was need for operation. Secondary outcomes included liver-related complications (LRCs) and mortality. RESULTS From 59 patients, 23 (39.0%) were managed with OBS and 36 (61.0%) with IR. 75% of IR patients underwent angioembolization, whereas 13% of OBS patients underwent any IR, all undergoing angioembolization. IR patients had an increased rate of operation (13.9% vs. 0%, p = 0.049), but no difference in LRCs (44.4% vs. 43.5%) or mortality (5.6% vs. 8.7%) versus OBS patients (both p > 0.05). CONCLUSION Over 60% of patients were managed with IR initially. IR patients had an increased rate of operation yet similar rates of LRCs and mortality, suggesting initial OBS reasonable in appropriately selected HGLI + Extrav patients.
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Affiliation(s)
- Negaar Aryan
- University of California, Irvine, Department of Surgery, Division of Trauma, Burns and Surgical Critical Care, USA.
| | - Areg Grigorian
- University of California, Irvine, Department of Surgery, Division of Trauma, Burns and Surgical Critical Care, USA.
| | - Erika Tay-Lasso
- University of California, Irvine, Department of Surgery, Division of Trauma, Burns and Surgical Critical Care, USA.
| | | | | | | | | | | | | | - Shana Ballow
- University of California, San Francisco-Fresno, USA.
| | | | | | | | - Deborah M Stein
- R Adams Cowley Shock Trauma Center, University of Maryland School of Medicine, USA.
| | | | | | | | - T J Mack
- Spartanburg Regional Medical Center, USA.
| | | | | | - Georgi Mladenov
- Division of Acute Care Surgery, Loma Linda University Health, USA.
| | - Daniel J Haase
- R Adams Cowley Shock Trauma Center, University of Maryland School of Medicine, Department of Emergency Medicine and Surgery, USA.
| | - Hossam Abdou
- R Adams Cowley Shock Trauma Center, University of Maryland School of Medicine, Department of Emergency Medicine and Surgery, USA.
| | | | | | | | | | | | | | | | | | | | | | - Vadine Eugene
- Dell Medical School, University of Texas at Austin, USA.
| | | | | | - Stephanie Bonne
- Rutgers, Division of Trauma and Surgical Critical Care, Department of Surgery, New Jersey Medical School, USA.
| | - Fatima S Elgammal
- Rutgers, Division of Trauma and Surgical Critical Care, Department of Surgery, New Jersey Medical School, USA.
| | | | | | - Nicole L Werner
- University of Wisconsin-Madison School of Medicine and Public Health, USA.
| | - James M Haan
- Ascension Via Christi Saint Francis, Department of Trauma Services, USA.
| | - Kelly Lightwine
- Ascension Via Christi Saint Francis, Department of Trauma Services, USA.
| | - Gregory Semon
- Wright State University / Miami Valley Hospital, USA.
| | | | | | - Jason M Samuels
- Vanderbilt University Medical Center, Section of Surgical Sciences, USA.
| | - M C Spalding
- Division of Trauma and Acute Care Surgery, Mount Carmel East, Columbus, OH, USA.
| | - Jeffry Nahmias
- University of California, Irvine, Department of Surgery, Division of Trauma, Burns and Surgical Critical Care, USA.
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2
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Brunese MC, Avella P, Cappuccio M, Spiezia S, Pacella G, Bianco P, Greco S, Ricciardelli L, Lucarelli NM, Caiazzo C, Vallone G. Future Perspectives on Radiomics in Acute Liver Injury and Liver Trauma. J Pers Med 2024; 14:572. [PMID: 38929793 PMCID: PMC11204538 DOI: 10.3390/jpm14060572] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2024] [Revised: 05/02/2024] [Accepted: 05/09/2024] [Indexed: 06/28/2024] Open
Abstract
Background: Acute liver injury occurs most frequently due to trauma, but it can also occur because of sepsis or drug-induced injury. This review aims to analyze artificial intelligence (AI)'s ability to detect and quantify liver injured areas in adults and pediatric patients. Methods: A literature analysis was performed on the PubMed Dataset. We selected original articles published from 2018 to 2023 and cohorts with ≥10 adults or pediatric patients. Results: Six studies counting 564 patients were collected, including 170 (30%) children and 394 adults. Four (66%) articles reported AI application after liver trauma, one (17%) after sepsis, and one (17%) due to chemotherapy. In five (83%) studies, Computed Tomography was performed, while in one (17%), FAST-UltraSound was performed. The studies reported a high diagnostic performance; in particular, three studies reported a specificity rate > 80%. Conclusions: Radiomics models seem reliable and applicable to clinical practice in patients affected by acute liver injury. Further studies are required to achieve larger validation cohorts.
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Affiliation(s)
- Maria Chiara Brunese
- Department of Medicine and Health Science “V. Tiberio”, University of Molise, 86100 Campobasso, Italy; (M.C.B.)
| | - Pasquale Avella
- Department of Clinical Medicine and Surgery, University of Naples Federico II, 80131 Naples, Italy
- Hepatobiliary and Pancreatic Surgery Unit, Pineta Grande Hospital, 81030 Castel Volturno, Italy
| | - Micaela Cappuccio
- Department of Clinical Medicine and Surgery, University of Naples Federico II, 80131 Naples, Italy
| | - Salvatore Spiezia
- Department of Medicine and Health Science “V. Tiberio”, University of Molise, 86100 Campobasso, Italy; (M.C.B.)
| | - Giulia Pacella
- Department of Medicine and Health Science “V. Tiberio”, University of Molise, 86100 Campobasso, Italy; (M.C.B.)
| | - Paolo Bianco
- Hepatobiliary and Pancreatic Surgery Unit, Pineta Grande Hospital, 81030 Castel Volturno, Italy
| | - Sara Greco
- Interdisciplinary Department of Medicine, Section of Radiology and Radiation Oncology, University of Bari “Aldo Moro”, 70124 Bari, Italy
| | | | - Nicola Maria Lucarelli
- Interdisciplinary Department of Medicine, Section of Radiology and Radiation Oncology, University of Bari “Aldo Moro”, 70124 Bari, Italy
| | - Corrado Caiazzo
- Department of Medicine and Health Science “V. Tiberio”, University of Molise, 86100 Campobasso, Italy; (M.C.B.)
| | - Gianfranco Vallone
- Department of Medicine and Health Science “V. Tiberio”, University of Molise, 86100 Campobasso, Italy; (M.C.B.)
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Malik MM, Khan NU, Alkuwaiti S, Hamza HM, Awan AA. Delayed Presentation of Severe Blunt Liver Trauma Following a 12-Foot Fall: A Case Report of a Grade 4 Hepatic Injury With a Concurrent Grade 1 Renal Injury. Cureus 2024; 16:e58179. [PMID: 38741848 PMCID: PMC11089588 DOI: 10.7759/cureus.58179] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/13/2024] [Indexed: 05/16/2024] Open
Abstract
The delayed presentation of a 15-year-old female with a complex Grade 4 liver injury and a concurrent Grade 1 renal injury sustained from a fall exemplifies the heightened vulnerability of adolescents to blunt hepatic trauma. Unlike typical presentations where symptoms like abdominal pain and internal bleeding appear immediately, this case emphasises the potential for delayed manifestation, posing unique challenges for diagnosis and management. This case, managed at a leading trauma centre, underscores the distinct challenges compared to adult cases due to adolescents' larger space available for the organ and immature livers. While presenting more management complexity than typical splenic injuries, prompt intervention with emergency laparotomy and hepatic packing proved crucial for the patient's successful outcome. This case emphasises the critical role of early identification, vigilant monitoring, and strict activity restrictions post-operatively for optimal adolescent liver trauma management and serves as a reminder of the spectrum of potential injuries, including bile duct and vascular damage alongside contusions and haematomas.
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Affiliation(s)
- Muiz M Malik
- School of Medicine, Foundation University School of Health Sciences, Islamabad, PAK
| | - Naveed U Khan
- Surgery, Federal Government Polyclinic Hospital Islamabad, Islamabad, PAK
| | | | - Hafiz Muhammad Hamza
- School of Medicine, Foundation University School of Health Sciences, Islamabad, PAK
| | - Ayaz A Awan
- School of Medicine, Foundation University School of Health Sciences, Islamabad, PAK
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4
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Alanezi T, Altoijry A, Alanazi A, Aljofan Z, Altuwaijri T, Iqbal K, AlSheikh S, Molla N, Altuwaijri M, Aloraini A, Altuwaijri F, Aldossary MY. Management and Outcomes of Traumatic Liver Injury: A Retrospective Analysis from a Tertiary Care Center Experience. Healthcare (Basel) 2024; 12:131. [PMID: 38255020 PMCID: PMC10815392 DOI: 10.3390/healthcare12020131] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2023] [Revised: 12/29/2023] [Accepted: 01/04/2024] [Indexed: 01/24/2024] Open
Abstract
BACKGROUND although liver injuries are one of the most critical complications of abdominal trauma, choosing when to operate on these injuries is challenging for surgeons worldwide. METHODS We conducted a retrospective analysis of liver injury cases at our institution from 2016 to 2022 to describe the operative and nonoperative management (NOM) outcomes in patients with traumatic liver injuries. Baseline patient characteristics, liver injury details, treatments, and outcomes were analyzed. RESULTS Data from 45 patients (male, 77.8%) were analyzed. The mean age was 29.3 years. Blunt trauma was the most common injury mechanism (86.7%), whereas penetrating injuries were 8.9% of cases. Conservative management was associated with 18.9% of complications. The overall complication rate was 26.7%; delirium and sepsis were the most common (13.3%), followed by acute renal failure (4.4%), pneumonia, biliary leaks, and meningitis/seizures. CONCLUSIONS Notwithstanding its limitations, this retrospective analysis demonstrated that NOM can serve as a safe and effective strategy for hemodynamically stable patients with liver trauma, irrespective of the patient's injury grade. Nevertheless, careful patient selection and monitoring are crucial. Further investigations are necessary to thoroughly evaluate the management of traumatic liver injuries, particularly in the context of multiorgan injuries.
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Affiliation(s)
- Tariq Alanezi
- College of Medicine, King Saud University, Riyadh 11322, Saudi Arabia (Z.A.)
| | - Abdulmajeed Altoijry
- Division of Vascular Surgery, Department of Surgery, College of Medicine, King Saud University, Riyadh 11322, Saudi Arabia; (T.A.); (K.I.); (S.A.); (M.Y.A.)
| | - Aued Alanazi
- College of Medicine, King Saud University, Riyadh 11322, Saudi Arabia (Z.A.)
| | - Ziyad Aljofan
- College of Medicine, King Saud University, Riyadh 11322, Saudi Arabia (Z.A.)
| | - Talal Altuwaijri
- Division of Vascular Surgery, Department of Surgery, College of Medicine, King Saud University, Riyadh 11322, Saudi Arabia; (T.A.); (K.I.); (S.A.); (M.Y.A.)
| | - Kaisor Iqbal
- Division of Vascular Surgery, Department of Surgery, College of Medicine, King Saud University, Riyadh 11322, Saudi Arabia; (T.A.); (K.I.); (S.A.); (M.Y.A.)
| | - Sultan AlSheikh
- Division of Vascular Surgery, Department of Surgery, College of Medicine, King Saud University, Riyadh 11322, Saudi Arabia; (T.A.); (K.I.); (S.A.); (M.Y.A.)
| | - Nouran Molla
- Department of Radiology and Medical Imaging, College of Medicine, King Saud University, Riyadh 11322, Saudi Arabia;
| | - Mansour Altuwaijri
- Division of Gastroenterology, Department of Medicine, College of Medicine, King Saud University, Riyadh 11322, Saudi Arabia;
| | - Abdullah Aloraini
- Division of General Surgery, Department of Surgery, College of Medicine, King Saud University, Riyadh 11322, Saudi Arabia;
| | - Fawaz Altuwaijri
- Department of Emergency Medicine, College of Medicine, King Saud University, Riyadh 11322, Saudi Arabia;
| | - Mohammed Yousef Aldossary
- Division of Vascular Surgery, Department of Surgery, College of Medicine, King Saud University, Riyadh 11322, Saudi Arabia; (T.A.); (K.I.); (S.A.); (M.Y.A.)
- Division of Vascular Surgery, Department of Surgery, Dammam Medical Complex, Dammam 32245, Saudi Arabia
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Segalini E, Morello A, Leati G, Di Saverio S, Aseni P. Primary angioembolization in liver trauma: major hepatic necrosis as a severe complication of a minimally invasive treatment-a narrative review. Updates Surg 2022; 74:1511-1519. [PMID: 36059024 PMCID: PMC9481502 DOI: 10.1007/s13304-022-01372-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2022] [Accepted: 08/27/2022] [Indexed: 11/25/2022]
Abstract
The liver is the second most commonly solid organ injured in blunt abdominal trauma. Liver injuries are classified according to the American Association for the Surgery of Trauma Injury Scale. The choice of Non-Operative Management is based on generalized clinical patients’ conditions combined with the evidence on CT scan imaging. To date, there are no consensus guidelines on appropriate patient selection criteria for those who would benefit from angiography and angioembolization. Major hepatic necrosis is a clinical condition of extended liver damage and is the most common complication after angioembolization. Large amounts of necrotic liver require therapy, but it is unclear if the better technique is debridements supplemented by percutaneous drainage procedures or definitive resection. A systematic review of the literature was performed with a computerized search in a database such as Medline for published papers on the use of angioembolization in trauma patients with hepatic injuries and on the most common complication, the major hepatic necrosis. The systematic review was conducted according to the recommendations of the 2020 updated Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) guidelines. A total of 3643 patients were included in the study, suffering liver trauma and 1703 (47%) were treated with Non-Operative Management; angioembolization was performed 10% of cases with a variable rate between 2 and 20%. Patients developed different complications. Hepatic necrosis accounted for 16% ranging from 0 to 42%. 74% of patients underwent operative management with a mortality rate of 11%. High-grade liver injuries pose significant challenges to surgeons who care for trauma patients. Many patients can be successfully managed nonoperatively. In hemodynamically stable patients with arterial blush, without other lesions requiring immediate surgery, selective and super-selective AE of the hepatic artery branches is an effective technique. However, these therapies are not without complications and major hepatic necrosis is the most common complication in high-grade injures. Level III, Systematic review
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Affiliation(s)
- Edoardo Segalini
- Department of General and Emergency Surgery, ASST Ospedale Maggiore, Crema, CR, Italy
| | - Alessia Morello
- Department of General and Emergency Surgery, ASST Ospedale Maggiore, Crema, CR, Italy
| | - Giovanni Leati
- Department of Interventional Radiology, ASST Ospedale Maggiore, Crema, CR, Italy
| | - Salomone Di Saverio
- Department of General Surgery, Ospedale Civile "Madonna del Soccorso", San Benedetto del Tronto, AP, Italy.
| | - Paolo Aseni
- Department of Emergency, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
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6
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[Interventional control of traumatic injuries of parenchymatous upper abdominal organs and the kidneys]. Unfallchirurg 2021; 124:621-626. [PMID: 34374807 DOI: 10.1007/s00113-021-01054-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/22/2021] [Indexed: 10/20/2022]
Abstract
Hemorrhage after trauma in the area of the upper abdominal organs and the kidneys can represent a life-threatening situation. The primary treatment options are conservative or surgical treatment. Only in exceptional cases can endovascular treatment with an angiographic depiction of the active bleeding and, if necessary, intervention by means of embolization be used as an alternative.
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Kanani A, Sandve KO, Søreide K. Management of severe liver injuries: push, pack, pringle - and plug! Scand J Trauma Resusc Emerg Med 2021; 29:93. [PMID: 34256814 PMCID: PMC8278654 DOI: 10.1186/s13049-021-00907-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2021] [Accepted: 06/17/2021] [Indexed: 11/16/2022] Open
Affiliation(s)
- Arezo Kanani
- Department of Gastrointestinal Surgery, Stavanger University Hospital, Stavanger, Norway
| | - Knut Olav Sandve
- Department of Radiology, Interventional Radiology Unit, Stavanger University Hospital, Stavanger, Norway
- Stavanger Medical Image Laboratory, Stavanger University Hospital, Stavanger, Norway
| | - Kjetil Søreide
- Department of Gastrointestinal Surgery, Stavanger University Hospital, Stavanger, Norway
- Department of Clinical Medicine, University of Bergen, Bergen, Norway
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