1
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Naseri R, Alishavandi F, Rajabian MS, Fard HA. Proper hepatic artery transection followed by blunt abdominal trauma: A case report and review of literature. Clin Case Rep 2024; 12:e9097. [PMID: 38915928 PMCID: PMC11194288 DOI: 10.1002/ccr3.9097] [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] [Received: 02/14/2024] [Revised: 05/25/2024] [Accepted: 06/05/2024] [Indexed: 06/26/2024] Open
Abstract
Abdominal vascular injuries, especially in the celiac trunk, are uncommon in blunt trauma, yet their life-threatening nature necessitates rapid surgical interventions to control possible massive bleedings. Damage control surgery principles may aid management. It is crucial to thoroughly assess all trauma patients, even in instances of initial normal physical examinations.
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Affiliation(s)
- Reyhaneh Naseri
- Thoracic and Vascular Surgery Research CenterShiraz University of Medical ScienceShirazIran
- School of MedicineShiraz University of Medical SciencesShirazIran
| | - Fatemeh Alishavandi
- School of MedicineShiraz University of Medical SciencesShirazIran
- Student Research Committee, School of MedicineShiraz University of Medical SciencesShirazIran
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2
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Lee JS, Lee JY, Sul Y, Kim SH, Ye JB, Yoon SY, Seok J, Han J, Choi JH, Kim HR, Kim Y. Successful endovascular treatment of an obstruction following the surgical repair of a traumatic portal vein injury: a case report. J Int Med Res 2023; 51:3000605231218954. [PMID: 38140951 DOI: 10.1177/03000605231218954] [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] [Indexed: 12/24/2023] Open
Abstract
Traumatic portal vein injury is rare, but the associated mortality rate ranges from 50% to 70%. The management of this injury is difficult and remains controversial. In this case report, we describe the successful endovascular treatment of an obstruction that developed following the surgical repair of a traumatic portal vein injury. A man in his mid-40s who had been injured in a car accident presented to our trauma center with abdominal pain, abdominal distension, and open wounds over both knees. Emergency laparotomy revealed a longitudinal rupture from the upper border of the pancreas to the mid-portion of the portal vein; his hemorrhage was successfully controlled surgically. However, postoperative abdominal computed tomography imaging revealed portal vein obstruction. One week after admission to the intensive care unit, an endovascular stent was successfully inserted into the patient's portal vein via a percutaneous transhepatic approach. The associated injuries, including the distal common bile duct obstruction, were successfully managed by choledochojejunostomy. The patient's postoperative recovery was uneventful. Thus, endovascular stent placement is an effective and safe means of treating an obstruction following the surgical repair of a traumatic portal vein injury.
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Affiliation(s)
- Jin Suk Lee
- Deparment of Trauma Surgery, Trauma Center, Chungbuk National University Hospital, Cheongju, Republic of Korea
| | - Jin Young Lee
- Deparment of Trauma Surgery, Trauma Center, Chungbuk National University Hospital, Cheongju, Republic of Korea
- Department of Trauma Surgery, College of Medicine, Chungbuk National University, Cheongju, Republic of Korea
| | - Younghoon Sul
- Deparment of Trauma Surgery, Trauma Center, Chungbuk National University Hospital, Cheongju, Republic of Korea
- Department of Trauma Surgery, College of Medicine, Chungbuk National University, Cheongju, Republic of Korea
| | - Se Heon Kim
- Deparment of Trauma Surgery, Trauma Center, Chungbuk National University Hospital, Cheongju, Republic of Korea
| | - Jin Bong Ye
- Deparment of Trauma Surgery, Trauma Center, Chungbuk National University Hospital, Cheongju, Republic of Korea
| | - Su Young Yoon
- Department of Cardiovascular and Thoracic Surgery, Trauma Center, Chungbuk National University Hospital, Cheongju, Republic of Korea
| | - Junepill Seok
- Department of Cardiovascular and Thoracic Surgery, Trauma Center, Chungbuk National University Hospital, Cheongju, Republic of Korea
| | - Jonghee Han
- Department of Cardiovascular and Thoracic Surgery, Trauma Center, Chungbuk National University Hospital, Cheongju, Republic of Korea
| | - Jung Hee Choi
- Department of Anesthesiology and Pain Medicine, Chungbuk National University Hospital, Cheongju, Republic of Korea
| | - Hong Rye Kim
- Department of Neurosurgery, Chungbuk National University Hospital, Cheongju, Republic of Korea
| | - Yook Kim
- Department of Radiology, College of Medicine, Chungbuk National University, Cheongju, Republic of Korea
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3
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Duodenal Injuries. CURRENT SURGERY REPORTS 2023. [DOI: 10.1007/s40137-023-00345-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/18/2023]
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4
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Rolff HC, Storkholm JH. Major vascular and pancreatic penetrating trauma in patient with pre-existing MALS. Trauma Case Rep 2023; 43:100757. [PMID: 36691628 PMCID: PMC9860451 DOI: 10.1016/j.tcr.2023.100757] [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: 01/06/2023] [Indexed: 01/08/2023] Open
Abstract
We report a case regarding a 24-year-old male with severe intraabdominal complex vascular lesions involving the superior mesenteric vein (SMV), portal vein (PV), inferior vena cava (IVC), the Common Hepatic and Gastroduodenal arteries (CHA and GDA) in combination with a total transection of the pancreatic neck following a single penetrating trauma to the upper abdomen. The management of the splanchnic vascular lesions were further complicated by the patient having pre-existing vascular condition known as Median Arcuate Ligament Syndrome (MALS). The MALS aspect makes this case unique and interesting to all trauma surgeons. Furthermore, this case report also reflects on the management of severe pancreatic trauma in the setting of the aforementioned vascular lesions.
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5
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Kumari D, Kwak DH, Fergus J. Role of Interventional Radiology in the Management of Venous Trauma. Semin Intervent Radiol 2022; 39:508-514. [PMID: 36561937 PMCID: PMC9767770 DOI: 10.1055/s-0042-1757941] [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: 12/24/2022]
Abstract
Traumatic injury to the large, central venous vasculature, although rare, is associated with high morbidity and mortality rates. Conventional open surgical treatment by repair or ligation can be technically challenging in anatomically difficult areas to expose. Furthermore, open surgical approach can release tension on the venous injury and result in uncontrollable bleeding. Endovascular techniques such as stenting and embolization can be used effectively for the treatment of traumatic venous injury. This article will discuss the morbidity and mortality associated with traumatic venous injuries, venous anatomy, endovascular treatment options, and management of traumatic venous injury.
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Affiliation(s)
- Divya Kumari
- Department of Radiology, University of Chicago Medicine, Chicago, Illinois
| | - Daniel H. Kwak
- Department of Radiology, University of Chicago Medicine, Chicago, Illinois
| | - Jonathan Fergus
- Department of Radiology, University of Chicago Medicine, Chicago, Illinois
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6
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Danial AK, Bedon M, Kalaji N, Nasra N, Khalil H. Isolated complete transection of common hepatic artery in a fall accident: a case report. J Surg Case Rep 2020; 2020:rjaa350. [PMID: 32994922 PMCID: PMC7505411 DOI: 10.1093/jscr/rjaa350] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2020] [Accepted: 08/06/2020] [Indexed: 11/13/2022] Open
Abstract
Blunt abdominal trauma is the most frequent external injury to the abdomen, which is rarely due to falling. However, not often does a blunt trauma cause injury to the common hepatic artery. Isolated injury of the common hepatic artery has rarely been reported in the literature. This report describes an unusual case of a falling accident from a height of 5 meters that results in complete transection of the common hepatic artery, yet all other abdominal organs are normal. The case was initially diagnosed by a Focused Assessment with Sonography in Trauma exam and confirmed with an exploratory laparotomy. The successful management would be an end-to-end anastomosis of the dissected artery. We hope we would raise awareness of such injury in order to facilitate its diagnosis and management and improve its outcome.
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Affiliation(s)
| | - Mario Bedon
- Faculty of Medicine, University of Aleppo, Aleppo 15310, Syria
| | - Nour Kalaji
- Faculty of Medicine, University of Aleppo, Aleppo 15310, Syria
| | - Nasri Nasra
- Faculty of Medicine, University of Aleppo, Aleppo 15310, Syria
| | - Hayat Khalil
- Faculty of Medicine, University of Aleppo, Aleppo 15310, Syria
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7
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Gazula S, Teja N, Mathur N, Srinivas M. Teratoma of Hepatoduodenal Ligament in Infancy: Precarious Location Posing a Grave Surgical Challenge. Indian J Surg Oncol 2020; 11:185-187. [PMID: 33364694 DOI: 10.1007/s13193-020-01138-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2020] [Accepted: 06/17/2020] [Indexed: 11/26/2022] Open
Affiliation(s)
- Suhasini Gazula
- Department of Pediatric Surgery, Employees State Insurance Corporation (ESIC) Superspeciality Hospital, Sanathnagar, Hyderabad, Telangana 500038 India
| | - Navya Teja
- Department of Pediatric Surgery, Employees State Insurance Corporation (ESIC) Superspeciality Hospital, Sanathnagar, Hyderabad, Telangana 500038 India
| | - Nimisha Mathur
- Department of Pediatric Surgery, Employees State Insurance Corporation (ESIC) Superspeciality Hospital, Sanathnagar, Hyderabad, Telangana 500038 India
| | - M Srinivas
- Department of Pediatric Surgery, Employees State Insurance Corporation (ESIC) Superspeciality Hospital, Sanathnagar, Hyderabad, Telangana 500038 India
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8
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Coccolini F, Kobayashi L, Kluger Y, Moore EE, Ansaloni L, Biffl W, Leppaniemi A, Augustin G, Reva V, Wani I, Kirkpatrick A, Abu-Zidan F, Cicuttin E, Fraga GP, Ordonez C, Pikoulis E, Sibilla MG, Maier R, Matsumura Y, Masiakos PT, Khokha V, Mefire AC, Ivatury R, Favi F, Manchev V, Sartelli M, Machado F, Matsumoto J, Chiarugi M, Arvieux C, Catena F, Coimbra R. Duodeno-pancreatic and extrahepatic biliary tree trauma: WSES-AAST guidelines. World J Emerg Surg 2019; 14:56. [PMID: 31867050 PMCID: PMC6907251 DOI: 10.1186/s13017-019-0278-6] [Citation(s) in RCA: 59] [Impact Index Per Article: 11.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2019] [Accepted: 11/18/2019] [Indexed: 12/12/2022] Open
Abstract
Duodeno-pancreatic and extrahepatic biliary tree injuries are rare in both adult and pediatric trauma patients, and due to their anatomical location, associated injuries are very common. Mortality is primarily related to associated injuries, but morbidity remains high even in isolated injuries. Optimal management of duodeno-bilio-pancreatic injuries is dictated primarily by hemodynamic stability, clinical presentation, and grade of injury. Endoscopic and percutaneous interventions have increased the ability to non-operatively manage these injuries. Late diagnosis and treatment are both associated to increased morbidity and mortality. Sequelae of late presentations of pancreatic injury and complications of severe pancreatic trauma are also increasingly addressed endoscopically and with interventional radiology procedures. However, for moderate and severe extrahepatic biliary and severe duodeno-pancreatic injuries, immediate operative intervention is preferred as associated injuries are frequent and commonly present with hemodynamic instability or peritonitis. The aim of this paper is to present the World Society of Emergency Surgery (WSES) and American Association for the Surgery of Trauma (AAST) duodenal, pancreatic, and extrahepatic biliary tree trauma management guidelines.
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Affiliation(s)
- Federico Coccolini
- General, Emergency and Trauma Surgery Department, Pisa University Hospital, Via Paradisa, 2, 56124 Pisa, Italy
| | - Leslie Kobayashi
- Division of Trauma, Surgical Critical Care, Burns and Acute Care Surgery, University of California San Diego, San Diego, USA
| | - Yoram Kluger
- Division of General Surgery, Rambam Health Care Campus, Haifa, Israel
| | | | - Luca Ansaloni
- General, Emergency and Trauma Surgery Department, Bufalini Hospital, Cesena, Italy
| | - Walt Biffl
- Trauma Surgery Department, Scripps Memorial Hospital, La Jolla, CA USA
| | - Ari Leppaniemi
- General Surgery Department, Mehilati Hospital, Helsinki, Finland
| | - Goran Augustin
- Department of Surgery, Zagreb University Hospital Centre and School of Medicine, University of Zagreb, Zagreb, Croatia
| | - Viktor Reva
- General and Emergency Surgery, Sergei Kirov Military Academy, Saint Petersburg, Russia
| | - Imitiaz Wani
- Department of Surgery, DHS Hospitals, Srinagar, Kashmir India
| | - Andrew Kirkpatrick
- General, Acute Care, Abdominal Wall Reconstruction, and Trauma Surgery, Foothills Medical Centre, Calgary, Alberta Canada
| | - Fikri Abu-Zidan
- Department of Surgery, College of Medicine and Health Sciences, UAE University, Al-Ain, United Arab Emirates
| | - Enrico Cicuttin
- General, Emergency and Trauma Surgery Department, Bufalini Hospital, Cesena, Italy
| | - Gustavo Pereira Fraga
- Trauma/Acute Care Surgery & Surgical Critical Care, University of Campinas, Campinas, Brazil
| | - Carlos Ordonez
- Trauma and Acute Care Surgery, Fundacion Valle del Lili, Cali, Colombia
| | - Emmanuil Pikoulis
- 3rd Department of Surgery, Attiko Hospital, National & Kapodistrian University of Athens, Athens, Greece
| | - Maria Grazia Sibilla
- General, Emergency and Trauma Surgery Department, Bufalini Hospital, Cesena, Italy
| | - Ron Maier
- Department of Surgery, Harborview Medical Centre, Seattle, USA
| | - Yosuke Matsumura
- Department of Emergency and Critical Care Medicine, Chiba University Hospital, Chiba, Japan
| | - Peter T. Masiakos
- Pediatric Trauma Service, Massachusetts General Hospital, Boston, MA USA
| | - Vladimir Khokha
- General Surgery Department, Mozir City Hospital, Mazyr, Belarus
| | - Alain Chichom Mefire
- Department of Surgery and Obstetrics and Gynecology, University of Buea, Buea, Cameroon
| | - Rao Ivatury
- General and Trauma Surgery, Virginia Commonwealth University, Richmond, VA USA
| | - Francesco Favi
- General, Emergency and Trauma Surgery Department, Bufalini Hospital, Cesena, Italy
| | - Vassil Manchev
- General and Trauma Surgery Department, Pietermaritzburg Hospital, Pietermaritzburg, South Africa
| | - Massimo Sartelli
- General and Emergency Surgery, Macerata Hospital, Macerata, Italy
| | - Fernando Machado
- General and Emergency Surgery Department, Montevideo Hospital, Montevideo, Uruguay
| | - Junichi Matsumoto
- Department of Emergency and Critical Care Medicine, Saint-Marianna University School of Medicine, Kawasaki, Japan
| | - Massimo Chiarugi
- General, Emergency and Trauma Surgery Department, Pisa University Hospital, Via Paradisa, 2, 56124 Pisa, Italy
| | - Catherine Arvieux
- Clin. Univ. de Chirurgie Digestive et de l’Urgence, CHUGA-CHU Grenoble Alpes, UGA-Université Grenoble Alpes, Grenoble, France
| | - Fausto Catena
- Emergency and Trauma Surgery, Maggiore Hospital, Parma, Italy
| | - Raul Coimbra
- Department of General Surgery, Riverside University Health System Medical Center, Moreno Valley, CA USA
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Howley IW, Stein DM, Scalea TM. Outcomes and complications for portal vein or superior mesenteric vein injury: No improvement in the era of damage control resuscitation. Injury 2019; 50:2228-2233. [PMID: 31635905 DOI: 10.1016/j.injury.2019.10.015] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/23/2019] [Revised: 09/18/2019] [Accepted: 10/06/2019] [Indexed: 02/02/2023]
Abstract
INTRODUCTION Portal vein (PV) and superior mesenteric vein (SMV) injuries are lethal. We hypothesised outcomes have improved with modern trauma care. METHODS We reviewed patients presenting to our Level 1 trauma centre over ten-years with PV/SMV injuries, analysing physiology, operative management, associated injuries, and outcomes. RESULTS Twenty-four patients had 7 PV and 15 SMV injuries, 2 had both; all had operative exploration. Sixty-seven percent had penetrating trauma. While many had normal vitals, profound acidosis was common. All patients had ≥2 additional abdominal injuries, liver most common (50%). Additional abdominal vascular injuries were more common in non-survivors than survivors: IVC 46% vs 22%, common hepatic artery 20% vs 0%, SMA 26% vs 11%. The mean injury severity score (ISS) was 32.4, and the mean new injury severity score (NISS) was 44.5. Mortality was 63%. Eleven patients died from exsanguination, two from SMV thrombosis, and two from sequelae of other injuries. All survivors had venorrhaphy, as did 8 non-survivors. Non-survivors were also shunted; had ligation; or bypass, shunting, and ligation. Three exsanguinated prior to repair. Two survivors had SMV related complications. One with proximal SMV injury developed severe venous congestion and multiple enterocutaneous fistulae. Another developed an arterioportal fistula, managed with embolisation and percutaneous portal vein stenting. CONCLUSION Despite advances (REBOA, damage control surgery and resuscitation, liberal use of ED thoracotomy), PV and SMV injuries remain lethal. Injuries to other structures are ubiquitous. Early exsanguination is the major cause of death. All survivors had successful venorrhaphy; those who required more complex repairs died. Compromised mesenteric venous flow causes morbidity and mortality.
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Affiliation(s)
- Isaac W Howley
- R Adams Cowley Shock Trauma Center, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Deborah M Stein
- Department of Surgery, University of California San Francisco School of Medicine, San Francisco, CA, USA.
| | - Thomas M Scalea
- R Adams Cowley Shock Trauma Center, University of Maryland School of Medicine, Baltimore, MD, USA.
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10
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Maithel S, Grigorian A, Kabutey NK, Sheehan BM, Gambhir S, Wolf RF, Jutric Z, Nahmias J. Hepatoportal Venous Trauma: Analysis of Incidence, Morbidity, and Mortality. Vasc Endovascular Surg 2019; 54:36-41. [DOI: 10.1177/1538574419878577] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Objectives: Although traumatic injuries to the superior mesenteric vein (SMV), portal vein (PV), and hepatic vein (HV) are rare, their impact is significant. Small single center reports estimate mortality rates ranging from 29% to 100%. Our aim is to elucidate the incidence and outcomes associated with each injury due to unique anatomic positioning and varied tolerance of ligation. We hypothesize that SMV injury is associated with a lower risk of mortality compared to HV and PV injury in adult trauma patients. Methods: The Trauma Quality Improvement Program database (2010-2016) was queried for patients with injury to either the SMV, PV, or HV. A multivariable logistic regression model was used for analysis. Results: From 1,403,466 patients, 966 (0.07%) had a single major hepatoportal venous injury with 460 (47.6%) involving the SMV, 281 (29.1%) involving the PV, and 225 (23.3%) involving the HV. There was no difference in the percentage of patients undergoing repair or ligation between SMV, PV, and HV injuries ( P > .05). Compared to those with PV and HV injuries, patients with SMV injury had a higher rate of concurrent bowel resection (38.5% vs 12.1% vs 7.6%, P < .001) and lower mortality (33.3% vs 45.9% vs 49.3%, P < .01). After controlling for covariates, traumatic SMV injury increased the risk of mortality (odds ratio [OR] 1.59, confidence interval [CI] = 1.00-2.54, P = .05) in adult trauma patients; however, this was less than PV injury (OR = 2.77, CI = 1.56-4.93, P = .001) and HV injury (OR = 2.70, CI = 1.46-4.99, P = .002). Conclusion: Traumatic SMV injury had a lower rate of mortality compared to injuries of the HV and PV. SMV injury increased the risk of mortality by 60% in adult trauma patients, whereas PV and HV injuries nearly tripled the risk of mortality.
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Affiliation(s)
- Shelley Maithel
- University of California, Irvine Medical Center, Orange, CA, USA
| | - Areg Grigorian
- University of California, Irvine Medical Center, Orange, CA, USA
| | - Nii-Kabu Kabutey
- University of California, Irvine Medical Center, Orange, CA, USA
| | - Brian M. Sheehan
- University of California, Irvine Medical Center, Orange, CA, USA
| | - Sahil Gambhir
- University of California, Irvine Medical Center, Orange, CA, USA
| | - Ronald F. Wolf
- University of California, Irvine Medical Center, Orange, CA, USA
| | - Zeljka Jutric
- University of California, Irvine Medical Center, Orange, CA, USA
| | - Jeffry Nahmias
- University of California, Irvine Medical Center, Orange, CA, USA
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11
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Gerrard AD, Lunevicius R, Heavey N. Traumatic bruising of the hepatoduodenal ligament can conceal a catastrophic injury to the hepatic artery. BMJ Case Rep 2019; 12:12/9/e230706. [PMID: 31537592 DOI: 10.1136/bcr-2019-230706] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
We present the case of a 22-year-old man transferred to the regional major trauma centre following a fall of ~15 m. He remained consistently haemodynamically stable for over 10 hours of observation until he deteriorated suddenly with major haemorrhagic shock requiring immediate trauma laparotomy. At laparotomy, 2 L of blood was drained from the abdomen but no source of active bleeding identified. 30 minutes after closure of the abdomen, 500 mL of fresh blood was noted in the drain so he was returned to the theatre where the bleeding source was found to be-after manual compression of a mildly bruised hepatoduodenal ligament-the proper hepatic artery (PHA). This case describes an unusual finding at relaparotomy and shows that even when there is no active bleeding from abdominal organs or classified vessels, it is possible to have isolated injury to PHA.
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Affiliation(s)
- Adam Daniel Gerrard
- Department of General Surgery, Aintree University Hospital NHS Foundation Trust, Liverpool, UK
| | - Raimundas Lunevicius
- Department of General Surgery, Aintree University Hospital NHS Foundation Trust, Liverpool, UK.,School of Medicine, University of Liverpool, Liverpool, UK
| | - Nicholas Heavey
- Aintree University Hospital NHS Foundation Trust, Liverpool, UK
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12
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Majdalany BS, Khaja MS, Sanogo ML, Saad WE. Percutaneous glue embolization for recalcitrant iatrogenic portal hemorrhage. ACTA ACUST UNITED AC 2019; 24:385-387. [PMID: 30406763 DOI: 10.5152/dir.2018.18181] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
N-butyl cyanoacrylate glue is well established as a transcatheter or direct injection embolic agent. Herein, targeted glue embolization was performed by direct needle injection into peripheral portal branches and along the surface of the liver to directly treat actively extravasating portal venous injury. In both cases, hemodynamically unstable patients underwent exploratory laparotomy, which was not able to definitively treat the hemorrhage. Subsequently, emergent visceral angiography and indirect portography revealed active portal phase extravasation. Transhepatic direct needle injection of the peripheral portal active extravasation with glue was successful in both cases and the patients stabilized, demonstrating this as an efficacious salvage approach.
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Affiliation(s)
- Bill S Majdalany
- Division of Vascular and Interventional Radiology, Department of Radiology, University of Michigan Health System, Ann Arbor, Michigan, USA
| | - Minhaj S Khaja
- Division of Vascular and Interventional Radiology, Department of Radiology, University of Michigan Health System, Ann Arbor, Michigan, USA
| | - Mamadou L Sanogo
- Division of Vascular and Interventional Radiology, Department of Radiology, University of Michigan Health System, Ann Arbor, Michigan, USA
| | - Wael E Saad
- Division of Vascular and Interventional Radiology, Department of Radiology, University of Michigan Health System, Ann Arbor, Michigan, USA
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13
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Al Humayed SM. Endoscopic Treatment of Biliary Leak Following Gunshot Injury: A Case Report. SAUDI JOURNAL OF MEDICINE AND MEDICAL SCIENCES 2018; 6:112-114. [PMID: 30787832 PMCID: PMC6196712 DOI: 10.4103/sjmms.sjmms_121_16] [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] [Indexed: 11/23/2022] Open
Abstract
This report describes the endoscopic treatment of a biliary leak following a gunshot injury in a young Saudi female. She was admitted to the emergency unit having sustained an accidental gunshot on the upper part of her right shoulder when her spouse was maintaining his gun sitting on a higher level chair. She was intubated and immediately taken for exploratory laparotomy, which revealed right liver lobe laceration and significant hemoperitoneum. Bleeding was controlled surgically, and two peritoneal lavage catheters were inserted for drainage. However, about 300–400 ml of bile drainage was observed daily. Accordingly, endoscopic retrograde cholangiopancreatography (ERCP) was performed, which demonstrated a biliary leak. Sphincterotomy was performed and a stent was inserted, following which bile drainage gradually reduced, and stopped after 5 days. A follow-up ERCP was performed 10 weeks later, and no further leak was observed. This is the first case report of a successful endoscopic treatment of traumatic biliary injuries due to a gunshot in Saudi Arabia. ERCP is a valuable method in the treatment of a traumatic bile leak.
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Affiliation(s)
- Suliman M Al Humayed
- Department of Internal Medicine, College of Medicine, King Khalid University, Abha, Saudi Arabia
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14
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Karaolanis G, Moris D, McCoy CC, Tsilimigras DI, Georgopoulos S, Bakoyiannis C. Contemporary Strategies in the Management of Civilian Abdominal Vascular Trauma. Front Surg 2018; 5:7. [PMID: 29516005 PMCID: PMC5826055 DOI: 10.3389/fsurg.2018.00007] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2017] [Accepted: 01/29/2018] [Indexed: 12/17/2022] Open
Abstract
The evaluation and management of patients with abdominal vascular trauma or injury requires immediate and effective decision-making in these unfavorable circumstances. The majority of these patients arrive at trauma centers in profound shock, secondary to massive blood loss, which is often unrelenting. Moreover, ischemia, compartment syndrome, thrombosis, and embolization may also be life threatening and require immediate intervention. To minimize the risk of these potentially lethal complications, early understanding of the disease process and emergent therapeutic intervention are necessary. In the literature, the management of acute traumatic vascular injuries is restricted to traditional open surgical techniques. However, in penetrating injuries surgeons often face a potentially contaminated field, which renders the placement of prosthetic grafts inappropriate. Currently, however, there are sparse data on the management of vascular trauma with endovascular techniques. The role of endovascular technique in penetrating abdominal vascular trauma, which is almost always associated with severe active bleeding, is limited. It is worth mentioning that hybrid operating rooms with angiographic radiology capabilities offer more opportunities for the management of this kind of injuries by either temporary control of the devastating bleeding using endovascular balloon tamponade or with embolization and stenting. On the other hand, blunt abdominal injuries are less dangerous and they could be treated at most times by endovascular means. Since surgeons continue to encounter abdominal vascular trauma, open and endovascular techniques will evolve constantly giving us encouraging messages for the near future.
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Affiliation(s)
- Georgios Karaolanis
- First Department of Surgery, Division of Vascular Surgery, National and Kapodistrian University of Athens, Athens, Greece
| | - Dimitrios Moris
- Department of Surgery, Duke University Hospital, Durham, NC, United States
| | - C. Cameron McCoy
- Department of Surgery, Duke University Hospital, Durham, NC, United States
| | - Diamantis I. Tsilimigras
- First Department of Surgery, Division of Vascular Surgery, National and Kapodistrian University of Athens, Athens, Greece
| | - Sotirios Georgopoulos
- First Department of Surgery, Division of Vascular Surgery, National and Kapodistrian University of Athens, Athens, Greece
| | - Chris Bakoyiannis
- First Department of Surgery, Division of Vascular Surgery, National and Kapodistrian University of Athens, Athens, Greece
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15
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Ravikumar VR, Rajamani G, Raju V, Sundar R, Ravikumar S, Maniam R. Teratoma Arising from Hepato Duodenal Ligament in the Newborn with Transection of Portal Vein, Hepatic Artery and Common Bile Duct: A Surgical Challenge. J Indian Assoc Pediatr Surg 2018; 23:45-47. [PMID: 29386766 PMCID: PMC5772097 DOI: 10.4103/jiaps.jiaps_131_17] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
A 7-day-old neonate presented with a large intra-abdominal mass adherent to the hilum of the liver encasing the portal triad. During excision, the portal vein, hepatic artery, and common bile duct were injured. The repair was done promptly and needed massive blood transfusion. Histopathology revealed immature teratoma Grade III. Survival in neonate following total transection of portal triad is rare and has not been reported.
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Affiliation(s)
- V R Ravikumar
- Department of Paediatric Surgery, G. Kuppuswamy Naidu Memorial Hospital, Coimbatore, Tamil Nadu, India
| | - G Rajamani
- Department of Paediatric Surgery, G. Kuppuswamy Naidu Memorial Hospital, Coimbatore, Tamil Nadu, India
| | - Vijayakumar Raju
- Department of Cardiothoracic Surgery, G. Kuppuswamy Naidu Memorial Hospital, Coimbatore, Tamil Nadu, India
| | - Rajani Sundar
- Department of Anaesthesia, G. Kuppuswamy Naidu Memorial Hospital, Coimbatore, Tamil Nadu, India
| | - Sowmya Ravikumar
- Department of Neonatology, G. Kuppuswamy Naidu Memorial Hospital, Coimbatore, Tamil Nadu, India
| | - Raghul Maniam
- Department of Paediatric Surgery, G. Kuppuswamy Naidu Memorial Hospital, Coimbatore, Tamil Nadu, India
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16
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Kelly P, Fung A, Qu J, Greig P, Tait G, Jenkinson J, McGilvray I, Agur A. Depicting surgical anatomy of the porta hepatis in living donor liver transplantation. J Vis Surg 2017; 3:43. [PMID: 29078606 DOI: 10.21037/jovs.2017.03.08] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2017] [Accepted: 02/09/2017] [Indexed: 12/16/2022]
Abstract
Visualizing the complex anatomy of vascular and biliary structures of the liver on a case-by-case basis has been challenging. A living donor liver transplant (LDLT) right hepatectomy case, with focus on the porta hepatis, was used to demonstrate an innovative method to visualize anatomy with the purpose of refining preoperative planning and teaching of complex surgical procedures. The production of an animation-enhanced video consisted of many stages including the integration of pre-surgical planning; case-specific footage and 3D models of the liver and associated vasculature, reconstructed from contrast-enhanced CTs. Reconstructions of the biliary system were modeled from intraoperative cholangiograms. The distribution of the donor portal veins, hepatic arteries and bile ducts was defined from the porta hepatis intrahepatically to the point of surgical division. Each step of the surgery was enhanced with 3D animation to provide sequential and seamless visualization from pre-surgical planning to outcome. Use of visualization techniques such as transparency and overlays allows viewers not only to see the operative field, but also the origin and course of segmental branches and their spatial relationships. This novel educational approach enables integrating case-based operative footage with advanced editing techniques for visualizing not only the surgical procedure, but also complex anatomy such as vascular and biliary structures. The surgical team has found this approach to be beneficial for preoperative planning and clinical teaching, especially for complex cases. Each animation-enhanced video case is posted to the open-access Toronto Video Atlas of Surgery (TVASurg), an education resource with a global clinical and patient user base. The novel educational system described in this paper enables integrating operative footage with 3D animation and cinematic editing techniques for seamless sequential organization from pre-surgical planning to outcome.
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Affiliation(s)
- Paul Kelly
- Division of General Surgery, Toronto General Hospital, University of Toronto, Toronto, Canada
| | - Albert Fung
- Division of General Surgery, Toronto General Hospital, University of Toronto, Toronto, Canada
| | - Joy Qu
- Division of General Surgery, Toronto General Hospital, University of Toronto, Toronto, Canada
| | - Paul Greig
- Division of General Surgery, Toronto General Hospital, University of Toronto, Toronto, Canada
| | - Gordon Tait
- Department of Anesthesia, Toronto General Hospital, University of Toronto, Toronto, Canada
| | - Jodie Jenkinson
- Department of Biology, Biomedical Communications, University of Toronto Mississauga, Mississauga, Canada
| | - Ian McGilvray
- Division of General Surgery, Toronto General Hospital, University of Toronto, Toronto, Canada
| | - Anne Agur
- Department of Anatomy, University of Toronto, Toronto, Canada
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17
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Giannakopoulos TG, Avgerinos ED. Management of Peripheral and Truncal Venous Injuries. Front Surg 2017; 4:46. [PMID: 28884115 PMCID: PMC5573711 DOI: 10.3389/fsurg.2017.00046] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2017] [Accepted: 08/08/2017] [Indexed: 12/19/2022] Open
Abstract
Civilian injuries are increasing according to the World Health Organization, and this is attributed mainly to road traffic accidents and urban interpersonal violence. Vascular injuries are common in these scenarios and are associated with high morbidity and mortality rates. Associated peripheral venous trauma is less likely to lead to death and controversy remains whether ligation or repair should be the primary approach. Conversely, non-compressible truncal venous insult can be lethal due to exsanguination, thus a high index of suspicion is crucial. Operative management is demanding with fair results but recent endovascular adjuncts demonstrate promising results and seem to be the way forward for these serious conditions.
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Affiliation(s)
| | - Efthymios D Avgerinos
- Division of Vascular Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA, United States
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18
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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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19
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Hamanaka K, Hirokawa Y, Itoh T, Fujino M, Kano K, Beppu S, Sasahashi N, Nishiyama K. Successful non-operative management of traumatic extrahepatic portal venous injury without intraperitoneal hemorrhage: a case report. Acute Med Surg 2016; 4:205-208. [PMID: 29123863 PMCID: PMC5667263 DOI: 10.1002/ams2.247] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2016] [Accepted: 08/21/2016] [Indexed: 11/16/2022] Open
Abstract
Case A 52‐year‐old woman was admitted to our hospital with hypotension after falling from the fifth floor of an apartment building. Contrast‐enhanced computed tomography showed liver injury with extravasation of contrast material from the hepatic artery, and extrahepatic portal venous injury with extravasation and pseudoaneurysm. Intra‐abdominal hemorrhage was not observed, and bleeding was confined to the retroperitoneal space. Hepatic arteriography showed extravasation, while portal venography showed pseudoaneurysm but no extravasation. After transarterial embolization, the patient's vital signs improved. Non‐operative management was selected for the portal venous injury. Outcome Computed tomography on the 58th hospital day revealed disappearance of the portal venous pseudoaneurysm. The patient was discharged on the 90th hospital day without any complications. Conclusion This case shows that non‐operative management can be selected for portal venous injury when there is no retroperitoneal injury and bleeding is confined to the retroperitoneal space.
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Affiliation(s)
- Kunio Hamanaka
- Department of Emergency and Critical Care Medicine National Hospital Organization Kyoto Medical Center Kyoto Japan
| | - Yuusuke Hirokawa
- Department of Radiology National Hospital Organization Kyoto Medical Center Kyoto Japan
| | - Tsuyoshi Itoh
- Department of Radiology National Hospital Organization Kyoto Medical Center Kyoto Japan
| | - Mitsuhiro Fujino
- Department of Emergency and Critical Care Medicine National Hospital Organization Kyoto Medical Center Kyoto Japan
| | - Kenichi Kano
- Department of Emergency and Critical Care Medicine National Hospital Organization Kyoto Medical Center Kyoto Japan
| | - Satoru Beppu
- Department of Emergency and Critical Care Medicine National Hospital Organization Kyoto Medical Center Kyoto Japan
| | - Nozomu Sasahashi
- Department of Emergency and Critical Care Medicine National Hospital Organization Kyoto Medical Center Kyoto Japan
| | - Kei Nishiyama
- Department of Emergency and Critical Care Medicine National Hospital Organization Kyoto Medical Center Kyoto Japan
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Abstract
Background and Aims: Jaundice in trauma patients may reflect serious underlying pathology. The aim of this review was to determine the appropriate diagnostic approach to the patient with jaundice following trauma. Methods: A MEDLINE search was performed to retrieve publications which outlined the causes of jaundice in trauma patients. Results: The main causes of jaundice in trauma patients were found to be bilirubin overload caused by breakdown of transfused- and extravasated blood and hepatic dysfunction caused by sepsis, infections, initial shock and systemic hypotension. Bile duct injury or drug induced liver injury are rare. Liver function tests are often uninformative but commonly show a cholestatic pattern. Ultrasound, CT or ERCP are the diagnostic imaging methods most widely used. Abdominal ultrasound and CT may reveal specific organ injuries, bile duct dilatation, intraabdominal fluid collections, hematomas or acalculus cholecystitis. ERCP is often diagnostic and permits a therapeutic intervention when a bile duct injury is present. Conclusions: The primary aim of the diagnostic approach should be to identify all cases of bile duct injury or obstruction. Sepsis and infections should be actively looked for. The number of blood transfusions must be calculated. Ultrasound, CT or ERCP are the diagnostic imaging methods most widely used.
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Affiliation(s)
- K J Labori
- Department of Gastroenterological Surgery and Institute for Experimental Medical Research, Ullevaal University Hospital, Oslo, Norway.
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21
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Park CI, Park SJ, Lee SB, Yeo KH, Choi SU, Kim SH, Kim JH, Baek DH. Successful Endoscopic Treatment of Hepatic Duct Confluence Injury after Blunt Abdominal Trauma: Case Report. JOURNAL OF TRAUMA AND INJURY 2016. [DOI: 10.20408/jti.2016.29.3.93] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Affiliation(s)
- Chan Ik Park
- Department of Trauma Surgery, Division of Gastroenterology, Pusan National University Hospital, Busan, Korea
| | - Sung Jin Park
- Department of Trauma Surgery, Division of Gastroenterology, Pusan National University Hospital, Busan, Korea
| | - Sang Bong Lee
- Department of Trauma Surgery, Division of Gastroenterology, Pusan National University Hospital, Busan, Korea
| | - Kwang Hee Yeo
- Department of Trauma Surgery, Division of Gastroenterology, Pusan National University Hospital, Busan, Korea
| | - Seon Uoo Choi
- Department of Trauma Surgery, Division of Gastroenterology, Pusan National University Hospital, Busan, Korea
| | - Seon Hee Kim
- Department of Trauma Surgery, Division of Gastroenterology, Pusan National University Hospital, Busan, Korea
| | - Jae Hun Kim
- Department of Trauma Surgery, Division of Gastroenterology, Pusan National University Hospital, Busan, Korea
| | - Dong Hoon Baek
- Department of Internal Medicine, Pusan National University Hospital, Busan, Korea
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22
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Coimbra R, Filho AR, Nesser RA, Rasslan S. Outcome from Traumatic Injury of the Portal and Superior Mesenteric Veins. Vasc Endovascular Surg 2016; 38:249-55. [PMID: 15181507 DOI: 10.1177/153857440403800309] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Traumatic injuries to the portal vein (PV) and superior mesenteric vein (SMV) are rare and carry a high mortality rate, and the best approach and method of repair is still subject to debate. The objective of the present study was to analyze risk factors for mortality in portal and superior mesenteric venous injuries. A retrospective analysis of 18 patients during a 5-year period was performed. Mechanism of injury, shock upon admission, Revised Trauma Score (RTS), Injury Severity Score (ISS), intraoperative fluid requirements, classification of venous injury severity, and associated injuries were analyzed as potential predictors of outcome. All patients were male, 9 were victims of gunshot wounds, and 11 were in shock at the time of admission. Eight patients sustained PV, and 12 sustained SMV injuries. The great majority of patients had more than 1 associated injury and 61% had an associated vascular injury. Mortality rate correlated with injury severity. Overall mortality rate was 72%. Nonsurvivors had higher ISS than survivors (24 ±0.4 and 20 ±1.7, respectively; p= 0.006). Uncontrollable intraoperative hemorrhage was the cause of death in 5 of 13 patients (38.4%). Six patients died during the postoperative period from complications of prolonged shock and multiple organ failure, and 2 died of sepsis. The physiologic status upon admission, the number of associated injuries, and the severity of the vascular injury are the most important factors related to mortality in PV and SMV injuries.
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Affiliation(s)
- Raul Coimbra
- University of California San Diego School of Medicine, CA, USA.
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23
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Kobayashi LM, Costantini TW, Hamel MG, Dierksheide JE, Coimbra R. Abdominal vascular trauma. Trauma Surg Acute Care Open 2016; 1:e000015. [PMID: 29766059 PMCID: PMC5891707 DOI: 10.1136/tsaco-2016-000015] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2016] [Revised: 06/25/2016] [Accepted: 06/30/2016] [Indexed: 02/07/2023] Open
Abstract
Abdominal vascular trauma, primarily due to penetrating mechanisms, is uncommon. However, when it does occur, it can be quite lethal, with mortality ranging from 20% to 60%. Increased early mortality has been associated with shock, acidosis, hypothermia, coagulopathy, free intraperitoneal bleeding and advanced American Association for the Surgery of Trauma Organ Injury Scale grade. These patients often arrive at medical centers in extremis and require rapid surgical control of bleeding and aggressive resuscitation including massive transfusion protocols. The most important factor in survival is surgical control of hemorrhage and restoration of appropriate perfusion to the abdominal contents and lower extremities. These surgical approaches and the techniques of definitive vascular repair can be quite challenging, particularly to the inexperienced surgeon. This review hopes to describe the most common abdominal vascular injuries, their presentation, outcomes, and surgical techniques to control and repair such injuries.
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Affiliation(s)
- Leslie M Kobayashi
- Division of Trauma, Surgical Critical Care, Burns and Acute Care Surgery, Department of Surgery, University of California San Diego, San Diego, California, USA
| | - Todd W Costantini
- Division of Trauma, Surgical Critical Care, Burns and Acute Care Surgery, Department of Surgery, University of California San Diego, San Diego, California, USA
| | - Michelle G Hamel
- Division of Trauma, Surgical Critical Care, Burns and Acute Care Surgery, Department of Surgery, University of California San Diego, San Diego, California, USA
| | - Julie E Dierksheide
- Division of Trauma, Surgical Critical Care, Burns and Acute Care Surgery, Department of Surgery, University of California San Diego, San Diego, California, USA
| | - Raul Coimbra
- Department of Surgery, Division of Trauma, Surgical Critical Care, and Burns, University of California, San Diego, California, USA
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24
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Abstract
Management of blunt or penetrating injury to the liver remains a significant challenge to trauma surgeons. Liver injury remains common in both blunt and penetrating trauma of the abdomen. Unstable patients require immediate laparotomy. Selective patients can be managed without surgery and with careful monitoring. There has been a recent resurgence in the role of temporary packing in the management of liver trauma. Other commonly used techniques are resectional debribement and suture ligation of bleeding vessels. Complications include haemorrhage, bile leak and sepsis. Mortality is mainly due to damage to major hepatic blood vessels or other associated non-hepatic injuries. With improved understanding of the major causes of death from hepatic injury, improved resuscitation and intensive care, mortality has fallen below 10%.
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Affiliation(s)
- I Ahmed
- Department of HPB Surgery, Queens Medical Centre, Nottingham University Hospitals, Nottingham, NG7 2UH, United Kingdom,
| | - IJ Beckingham
- Department of HPB Surgery, Queens Medical Centre, Nottingham University Hospitals, Nottingham, NG7 2UH, United Kingdom
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25
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26
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Abstract
Despite its relatively protected position, the liver is the most frequently injured solid intra-abdominal organ. 1 Most liver injuries can be managed conservatively, but about 5% to 10% require urgent laparotomy, usually when the mechanism of injury involves a vehicle accident and hemodynamic instability persists, in spite of 40 mL/kg of blood transfusion. 2 , 3 In particular, grades IV and V liver injuries may pose a challenge to the surgeon trying to control hemorrhage, the leading cause of mortality. 4 Traumatic injuries to the portal vein are rare but devastating. The mortality rate for portal vein injury ranges from 50% to 70%. A recent study of portal triad injuries has highighted the higher mortality rates associated with combination injuries involving multiple portal triad components, especially those that include portal vein injury. 5 This case study describes a unique case of relatively minor trauma in a child resulting in portal triad injury, sudden demise, and surgical repair.
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27
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Affiliation(s)
- George M. Testerman
- Holston Valley Hospital Level 1 Trauma Center, ETSU Department of Surgery, Kingsport, Tennessee
| | - Hao D. Pham
- Holston Valley Hospital Level 1 Trauma Center, ETSU Department of Surgery, Kingsport, Tennessee
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28
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29
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Nagem RG, Abrantes WL. Avulsion of common bile duct--case report. Rev Col Bras Cir 2013; 40:261-2. [PMID: 23912377 DOI: 10.1590/s0100-69912013000300017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2007] [Accepted: 06/20/2007] [Indexed: 11/22/2022] Open
Abstract
Common bile duct disruption from blunt trauma is very rare. Management, diagnosis and therapy by a non-specialist surgeon can be difficult. We describe a bile duct injury after a motor vehicle crash in a young male, treated with cholecystojejunostomy at his third laparotomy. We also briefly review some diagnostic aspects and therapeutic options from the literature.
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Affiliation(s)
- Rachid G Nagem
- Department of General Surgery, Servants Hospital of Minas Gerais - IPSEMG, Belo Horizonte, Minas Gerais State, MG, Brazil.
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30
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Fallon SC, Coker MT, Hernandez JA, Pimpalwar SA, Minifee PK, Fishman DS, Nuchtern JG, Naik-Mathuria BJ. Traumatic hepatic artery laceration managed by transarterial embolization in a pediatric patient. J Pediatr Surg 2013; 48:E9-12. [PMID: 23701809 DOI: 10.1016/j.jpedsurg.2013.02.066] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/31/2012] [Revised: 02/18/2013] [Accepted: 02/18/2013] [Indexed: 10/26/2022]
Abstract
While blunt abdominal trauma with associated liver injury is a common finding in pediatric trauma patients, hepatic artery transection with subsequent treatment by transarterial embolization has rarely been reported. We present a case of a child who suffered from a hepatic artery injury which was successfully managed by supraselective transarterial microcoil embolization, discuss management strategies in these patients, and provide a review of currently available literature.
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Affiliation(s)
- Sara C Fallon
- Division of Pediatric Surgery, Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, TX 77030, USA
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31
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Taslakian B, Ghaith O, Al-Kutoubi A. Isolated hepatic artery injury in blunt abdominal trauma presenting as upper gastrointestinal bleeding: treatment with transcatheter embolisation. BMJ Case Rep 2012; 2012:bcr-2012-007464. [PMID: 23162032 DOI: 10.1136/bcr-2012-007464] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Liver injury in blunt abdominal trauma is common. However, not often does blunt trauma cause injury to the anatomical structures of the porta hepatis. Isolated injury of the hepatic artery has been rarely reported in the literature. Such injury may be lethal and requires immediate diagnosis and management. This report describes an unusual case of blunt abdominal trauma resulting in hepatic and gastroduodenal artery dissection, with pseudoaneurysm formation complicated by active upper gastrointestinal bleeding. The injury was managed by transcatheter embolisation. Awareness of this diagnosis should facilitate management of similar trauma cases.
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Affiliation(s)
- Bedros Taslakian
- Department of Diagnostic Radiology, American University of Beirut Medical Center, Beirut, Lebanon
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32
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Jain S, Jain A, Shrivastava SK. Isolated common bile duct avulsion following blunt abdominal trauma. Indian J Surg 2012; 75:199-200. [PMID: 24426563 DOI: 10.1007/s12262-012-0636-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2011] [Accepted: 06/12/2012] [Indexed: 10/28/2022] Open
Abstract
Isolated injuries to common bile duct following blunt abdominal trauma is extremely rare. Delayed presentation and diagnosis is common and results in significant morbidity and mortality. We present here a case with such an injury. Emphasis on mechanism of injury and clinico-radiological signs with use of diagnostic laparoscopy can help in making a timely diagnosis.
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Affiliation(s)
- Sandeep Jain
- Department of General Surgery, Pushpanjali Crosslay Hospital, Vaishali, Sector-1, Ghaziabad, Uttar Pradesh India
| | - Ajay Jain
- Department of General Surgery, Pushpanjali Crosslay Hospital, Vaishali, Sector-1, Ghaziabad, Uttar Pradesh India
| | - Sanjeev Kumar Shrivastava
- Department of General Surgery, Pushpanjali Crosslay Hospital, Vaishali, Sector-1, Ghaziabad, Uttar Pradesh India
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33
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Whitlaw MJ, Trehan DK, Bautz PC. Isolated gall bladder rupture following blunt trauma. ANZ J Surg 2012; 82:470-1. [PMID: 22672399 DOI: 10.1111/j.1445-2197.2012.06095.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- Michael J Whitlaw
- Department of Surgery, Royal Adelaide Hospital, Adelaide, South Australia, Australia
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35
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Holly BP, Steenburg SD. Multidetector CT of blunt traumatic venous injuries in the chest, abdomen, and pelvis. Radiographics 2012; 31:1415-24. [PMID: 21918052 DOI: 10.1148/rg.315105221] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Venous injuries as a result of blunt trauma are rare. Even though current protocols for multidetector computed tomography (CT) of patients with trauma are designed to evaluate primarily the solid organs and arteries, blunt venous injuries may nevertheless be identified, or at least suspected, on the basis of the multidetector CT findings. Venous injuries are associated with high morbidity and mortality rates. Diagnosis of a possible venous injury is crucial because the physical findings of a venous injury are nonspecific and may be absent. This article aims to make the radiologist aware of various venous injuries caused by blunt trauma and to provide helpful hints to aid in the identification of venous injuries. Multidetector CT technology, in combination with interactive manipulation of the raw dataset, can be useful in the creation of multiplanar reconstructed images and in the identification of a venous injury caused by blunt trauma. Familiarity with direct and indirect signs of venous injuries, as well as with examples of blunt traumatic venous injuries in the chest, abdomen, and pelvis, will help in the diagnosis of these injuries.
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Affiliation(s)
- Brian P Holly
- Department of Diagnostic Radiology, University of Maryland Medical Center, Baltimore, MD 21201, USA.
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36
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Fraga GP, Bansal V, Fortlage D, Coimbra R. A 20-year experience with portal and superior mesenteric venous injuries: has anything changed? Eur J Vasc Endovasc Surg 2008; 37:87-91. [PMID: 18993088 DOI: 10.1016/j.ejvs.2008.09.018] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2008] [Accepted: 09/23/2008] [Indexed: 12/17/2022]
Abstract
OBJECTIVES To identify predictive factors causing mortality in patients with injuries to the portal (PV) and superior mesenteric veins (SMV). DESIGN Retrospective analysis of prospectively collected data. MATERIALS AND METHODS Adults admitted with blunt or penetrating PV and SMV injuries at an academic level I trauma center during a 20-year period. RESULTS Of 26,387 major trauma victims admitted from 1987 through 2006, 26 sustained PV or SMV injuries (PV=15, SMV=11). Mechanism of injury was penetrating in 19 (73%) and 20 were in shock. Active hemorrhage occurred in 21. Most patients had associated injuries (2.9+/-1.8/patient). Mean Injury Severity Score (ISS) was 27.8+/-16.8. All PV injuries underwent suture repair and 27% of SMV injuries were ligated. Overall mortality was 46% (PV=47%, SMV=45%). Stab wounds had a lower mortality (31%) compared to gunshot wounds (67%) and blunt injuries (57%). Nonsurvivors had a higher ISS (35.8 vs. 20.9; p=0.02), more associated injuries (3.7 vs. 2.2; p=0.02), were older, and had active hemorrhage. Active hemorrhage (p=0.04) was independently related to death while shock on admission (odds ratio=6.1, p=0.61) trended toward higher mortality. CONCLUSION Despite improvements in trauma care, mortality of PV and SMV injuries remains high. Shock, active hemorrhage, and associated injuries were predictive of increased mortality.
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Affiliation(s)
- G P Fraga
- Department of Surgery, Division of Trauma, University of California San Diego, School of Medicine, San Diego, CA 92103-8896, USA
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37
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Cothren CC, Moore EE. Hepatic Trauma. Eur J Trauma Emerg Surg 2008; 34:339-54. [PMID: 26815811 DOI: 10.1007/s00068-008-8029-5] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2008] [Accepted: 04/09/2008] [Indexed: 11/24/2022]
Abstract
Hepatic injuries are one of the most common abdominal injuries following either blunt or penetrating trauma. CT scanning has revolutionized the treatment algorithm for these patients. The majority of patients are successfully treated with nonoperative management, but surgeons should have a clear understanding of the indications for operative intervention. An array of techniques including operative, interventional, and endoscopic, are often required for management of advanced grade hepatic injuries.
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Affiliation(s)
- Clay C Cothren
- Department of Surgery, Denver Health Medical Center and the University of Colorado at Denver School of Medicine, 777 Bannock Street, MC 0206, Denver, CO, 80204, USA.
| | - Ernest E Moore
- Department of Surgery, Denver Health Medical Center and the University of Colorado at Denver School of Medicine, Denver, CO, USA
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Hill JS, Shankar S, Evans DB, Tseng JF. Control of Bleeding from the Portal/Superior Mesenteric Vein. ACTA ACUST UNITED AC 2007. [DOI: 10.1053/j.optechgensurg.2008.02.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Kirchhoff C, Stegmaier J, Krotz M, Muetzel Rauch E, Mutschler W, Kanz KG, Heindl B. Celiac dissection after blunt abdominal trauma complicated by acute hepatic failure: case report and review of literature. J Vasc Surg 2007; 46:576-80. [PMID: 17826250 DOI: 10.1016/j.jvs.2007.04.041] [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] [Received: 02/19/2007] [Accepted: 04/11/2007] [Indexed: 12/12/2022]
Abstract
Injuries of the abdominal visceral vessels are uncommon but devastating entities resulting in extremely high rates of mortality. The most common cause of abdominal vascular injuries is penetrating trauma, accounting for 90% to 95% of these injuries. In contrast, blunt trauma accounts for 5% to 10% of all abdominal vascular lesions. Although traumatic injury to the celiac artery is among the rarest of all vascular injuries, mortality can be as high as 75%. We report a 66-year-old patient who sustained multiple injuries in a motor vehicle crash. The initial whole-body computed tomography (CT) scan revealed a combination of severe brain injury and bilateral thoracic lesions. On day 6 after the accident, the patient's clinical situation deteriorated rapidly. At this time, the abdominal arterial CT scan showed a dissection of the celiac artery. Therapeutic anticoagulation was not feasible because of the intracranial hemorrhage. Also the patient's clinical situation worsened so rapidly that interventional therapy, including surgical and endovascular treatment, could not be performed. Finally, the patient died of fulminant hepatic failure, therefore not surviving a potentially treatable injury. The diagnosis of celiac artery dissection in this patient was significantly delayed because the initial trauma CT protocol did not include an arterial phase of the abdominal vessels.
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Affiliation(s)
- Chlodwig Kirchhoff
- Department of Traumatology and Orthopaedic Surgery, Campus Innenstadt, Ludwig-Maximilians University Munich, Munich, Germany.
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Scott FE, Salyer D, Omert L, Hughes KM, Rodriguez A. Porta hepatis injury: a multidisciplinary approach. THE JOURNAL OF TRAUMA 2007; 62:1284-5. [PMID: 17495738 DOI: 10.1097/01.ta.0000195507.27907.3b] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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41
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Vivarelli M, Lauro A, Cucchetti A, D'Errico A, Pironi L, Pinna AD. Effect of total enterectomy, pancreatectomy, and portal vein ligation on liver function and histology: a case report. Transplant Proc 2007; 39:300-2. [PMID: 17275528 DOI: 10.1016/j.transproceed.2006.10.209] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2006] [Indexed: 11/24/2022]
Abstract
Impaired hepatic function and histology have been observed in experimental models of diversion of the portal vein blood inflow from the liver and among patients with intestinal failure. Survival after total enterectomy, pancreatectomy, and portal vein ligation, and the effect of such a condition on liver function have never been reported in humans. Herein a 32-year-old woman with familial adenomatous polyposis and multiple desmoid tumors involving the mesentery and the retroperitoneum underwent total enterectomy and pancreatectomy followed by en bloc transplantation of the stomach, small bowel, and pancreas. Due to early graft failure, the patient underwent graftectomy, ligation of the portal vein, and external drainage of the common bile duct. Liver function tests were checked daily and a liver biopsy performed 15 days after graftectomy. The patient died of a ruptured mycotic aneurysm of the abdominal aorta at 27 days after the graftectomy. Liver function tests remained normal throughout the postoperative period; liver biopsy showed normal hepatic architecture with mild portal inflammation and cholestasis and spotty necrosis. Total enterectomy with pancreatectomy and ligation of the portal vein are compatible with survival in humans (at least in the short term), allowing normal hepatic function with minimal histological alterations to the liver.
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Affiliation(s)
- M Vivarelli
- Department of Surgery, University of Bologna, S Orsola Hospital, Bologna, Italy
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Pey F, Bureau C, Otal P, Vinel JP, Rousseau H. Anomalies congénitales et acquises du système porte. ACTA ACUST UNITED AC 2007. [DOI: 10.1016/s1155-1976(07)41406-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
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43
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Ripley RT, Cothren CC, Johnson JL, Moore EE. Hepatic artery avulsion secondary to blunt abdominal trauma. THE JOURNAL OF TRAUMA 2006; 61:1022. [PMID: 17033585 DOI: 10.1097/01.ta.0000197927.36252.aa] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Affiliation(s)
- R Taylor Ripley
- Department of Surgery, Denver Health Medical Center and The University of Colorado Health Sciences Center, Denver, Colorado 80204, USA.
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44
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Miglietta MA, Moore JA, Bernstein MP, Frangos SG, Ginsburg H, Pachter HL. Hepatic artery transection after blunt trauma: case presentation and review of the literature. J Pediatr Surg 2006; 41:1604-6. [PMID: 16952600 DOI: 10.1016/j.jpedsurg.2006.05.001] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Hepatic artery injuries sustained as a result of blunt abdominal trauma are rare. This case represents the first reported hepatic artery transection and the second hepatic artery injury described in children. Hepatic artery injuries are associated with high mortality, and their management is complex and controversial.
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Affiliation(s)
- Maurizio A Miglietta
- New York University School of Medicine, Department of Surgery, Bellvue Hospital Center, New York, NY 10016, USA.
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45
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Abstract
This paper reviews the surgical management of vascular injuries. Precise clinical and ultrasound evaluation is mandatory during the first steps of emergency treatment. For further documentation of the extent and site of arterial injuries in hemodynamically stable patients, computed tomography and angiography are crucial in differential diagnosis. Especially during the acute phase, the latter is indicated for evaluating the interventional therapy. The key to successful treatment of vascular injuries is immediate surgical control of hemorrhaging vessels.
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MESH Headings
- Abdomen/blood supply
- Abdominal Injuries/diagnosis
- Abdominal Injuries/etiology
- Abdominal Injuries/surgery
- Aortic Dissection/diagnosis
- Aortic Dissection/etiology
- Aortic Dissection/surgery
- Aneurysm, False/diagnosis
- Aneurysm, False/etiology
- Aneurysm, False/surgery
- Aorta/injuries
- Aorta/surgery
- Aortic Aneurysm/diagnosis
- Aortic Aneurysm/etiology
- Aortic Aneurysm/surgery
- Aortic Rupture/diagnosis
- Aortic Rupture/etiology
- Aortic Rupture/surgery
- Aortography
- Arteries/injuries
- Arteries/surgery
- Humans
- Image Processing, Computer-Assisted
- Imaging, Three-Dimensional
- Ischemia/diagnosis
- Ischemia/etiology
- Ischemia/surgery
- Multiple Trauma/diagnosis
- Multiple Trauma/etiology
- Multiple Trauma/surgery
- Pelvis/blood supply
- Pelvis/injuries
- Pulmonary Veins/injuries
- Pulmonary Veins/surgery
- Thoracic Arteries/injuries
- Thoracic Arteries/surgery
- Thoracic Injuries/diagnosis
- Thoracic Injuries/etiology
- Thoracic Injuries/surgery
- Tomography, X-Ray Computed
- Veins/injuries
- Veins/surgery
- Vena Cava, Superior/surgery
- Wounds, Nonpenetrating/diagnosis
- Wounds, Nonpenetrating/etiology
- Wounds, Nonpenetrating/surgery
- Wounds, Penetrating/diagnosis
- Wounds, Penetrating/etiology
- Wounds, Penetrating/surgery
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Affiliation(s)
- G Halter
- Abteilung für Thorax- und Gefässchirurgie, Universitätsklinikum Ulm.
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Abstract
BACKGROUND Injuries to the portal vein are rare but devastating. Contemporary studies have debated the most effective management for this injury. The purpose of this case study was to provide an update on portal vein injury and add information regarding its management. METHODS A retrospective review investigated the 10-year experience with portal vein injury in a level 1 trauma center. RESULTS Of the 18,900 trauma patients (0.08%) evaluated during a 10-year period, 15 sustained injuries to the portal vein. All the injuries resulted from penetrating trauma, and the overall survival rate was 60% (9 of the 15 patients). Four patients died of exsanguination and two patients died later as a result of multisystem organ failure. Postoperative complications were common. Sepsis and wound infection were the most common postoperative complications, occurring in seven (78%) of the nine survivors. All the patients had associated nonvascular injuries, whereas 9 (60%) of the 15 had associated vascular injuries. Associated injuries to the other structures in the portal triad occurred in 7 (47%) of the 15 patients, and 5 (71%) of these patients survived. Survival rates by procedure were 86% for venorrhaphy and 67% for ligation. CONCLUSIONS Injuries to the portal vein are rare. In this study, exsanguination was the main cause of death. The key to a favorable outcome is prompt control of hemorrhage with an early decision to proceed with either venorrhaphy or ligation. Ligation can be effective for the management of hemodynamically unstable patients.
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Affiliation(s)
- Jonathan Pearl
- Department of Surgery, National Naval Medical Center, Bethesda, Maryland, USA
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47
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Kurbel S, Kurbel B, Vcev A, Loncar B, Vegar-Brozović V, Cavcić J. A model of dual circulation in liver acini with hypoxia regulated adenosine secretion. Med Hypotheses 2003; 60:515-9. [PMID: 12615512 DOI: 10.1016/s0306-9877(02)00448-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
It was postulated by W.W. Lautt that the hepatic artery flow compensation for changes in portal vein flow (the 'hepatic arterial buffer response') is regulated through the portal blood washout of adenosine from the small fluid compartment that surrounds the hepatic arterial resistance vessels. It is presumed that the adenosine secretion there is constant and independent of oxygen supply or liver demand. It was reported by others that liver secretes variable quantities of adenosine and that secretion is related to the level of liver hypoxia. This paper is an attempt to describe a model of acinar circulation without sources of constant adenosine secretion. The presented model is based on the fact that portal blood enters acinar space near the vascular stalk in the zone 1, while most of the arterial branches empty one-third from the interlobular septa, at the beginning of the zone 2, just downstream from the zone 1. Another important characteristic of liver architecture is that near 5/9 of lobular volume is in the zone 1. Liver cells in zone 1 are well oxygenated by the portal blood and they have low adenosine secretion that might seem almost constant. Since most arterial branches empty more peripherally, the zone 1 normally does not depend on the arterial circuit and most of arterial branches are governed by the adenosine secretion from the upstream zone 1. Low portal flow, would increase adenosine secretion from the zone 1 and thus dilate numerous downstream arterial resistance vessels. An increased flow from these arterial vessels would compensate any decrease in the portal flow. Zones 2 and 3 probably have higher adenosine secretion rates since the oxygenation depends on the amount of added arterial blood and on the liver cell metabolism. Some of the arterial branches in those zones are probably open all the time, preserving them zones from hypoxic injury. Since the main point for arterial inflow is concentrated downstream from the zone 1, in cases of low portal pressures, or elevated upstream resistance, some of the arterial blood might leave the acinus in retrograde direction via the portal branch and enter some other acinus as a part of portal blood. These arterio-portal communications might be important in cases of low or none portal flow when zone 1 is in hypoxia. In the 3D liver space with tightly packed acini, very complex and ever-changing patterns of combined antegrade and retrograde flows can be expected.
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Affiliation(s)
- Sven Kurbel
- Department of Physiology, Osijek Medical Faculty, University JJ Strossmayer, Osijek, Croatia.
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Abstract
OBJETIVO: O trauma da veia porta é raro e freqüentemente fatal por causa de exsanguinação e alta incidência de lesões de estruturas adjacentes. Devido às pecualiaridades desta lesão e diferentes condutas propostas na literatura, o objetivo dos autores é relatar a experiência neste tipo de lesão. MÉTODO: Estudo retrospectivo, de janeiro de 1994 e dezembro de 2001, de 1370 pacientes submetidos à laparotomia devido trauma abdominal. Entre esses, 15 pacientes apresentavam lesão da veia porta. As lesões foram classificadas conforme a sua extensão e localização. RESULTADOS: O mecanismo de trauma predominante foi o penetrante. O diagnóstico da lesão foi realizado no intraoperatório. Os procedimentos executados foram: sutura, anastomose término-terminal e ligadura da veia porta. A mortalidade foi de 53,3%. CONCLUSÃO: A lesão da veia porta possui alta taxa de mortalidade e o atendimento adequado está diretamente relacionado à sobrevida.
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49
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Sharpe RP, Nance ML, Stafford PW. Nonoperative management of blunt extrahepatic biliary duct transection in the pediatric patient: case report and review of the literature. J Pediatr Surg 2002; 37:1612-6. [PMID: 12407549 DOI: 10.1053/jpsu.2002.36194] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
An 11-year-old boy sustained a grade IV liver injury and complete disruption of the left hepatic duct (LHD) secondary to a sledding accident. Although he became hemodynamically stable after initial resuscitation in the emergency department and the intensive care unit (ICU), serial paracentesis procedures were necessary to manage abdominal compartment syndrome (ACS). The fluid initially was serosanguinous but subsequently became bile stained. A bile leak was confirmed by a technetium 99m dimethyliminodiacetic acid (HIDA) scan and an endoscopic retrograde cholangiogram (ERCP). The LHD transection was treated with percutaneous drainage of the subhepatic space and a transampullary biliary stent. The leak sealed within 8 days, and follow-up ERCP as an outpatient showed no extravasation but could not visualize the LHD. Repeat computed tomography (CT) scan 3(1/2) months after injury showed the liver laceration to be healed with atrophy of the left lobe and no ductal dilatation. The patient has had a complete recovery, resumed all activities, and currently is 20 months after his injury with no sequelae.
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Affiliation(s)
- Richard P Sharpe
- Department of Pediatric General and Thoracic Surgery, The Children's Hospital of Philadelphia, PA 19104, USA
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50
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Mantovani M, Leal RF, Fontelles MJ. Anatomic study of portal vein: transpancreatic vessels injuries approach. Acta Cir Bras 2002. [DOI: 10.1590/s0102-86502002000400005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Introduction: The commitment of the great blood-vessels make up a situation of great complexity and a high rate of the complications and mortality patients with abdominal trauma. The injury of the portal vein matters because of the difficulty on the diagnosis and the approach surgery. Objective: To set the standard on the transverse section of the pancreas looking for a safer surgical access to repair the portal vein injuries. Methods: A quantitative analysis was performed to characterize the anatomical relationship between the portal vein and their tributaries relating them to the pancreas. On these corpses, the measurements of a anatomical triangle were studied. It base was the upper limit of the superior mesenteric vein and the initial portion of the portal vein; the apex, a point located on the upper limit of the confluence of the splenic vein and superior mesenteric vein, situated at the middle line of the superior mesenteric_ vein. Results: The portal vein is formed 3.24cm from the internal border of the duodenal arc at a distance of 1.61cm and 1.07 from the inferior and superior pancreas borders, respectively. Conclusion: The present study allow us to conclude that, to have access to the origin of the portal vein, in case of trauma of this vessel, one should proceed a transverse section of the neck of the pancreas next to the superior mesenteric vein, because its confluence with splenic vein occur, on average, 1.07cm and 1.61cm from the superior and inferior border of the gland, respectively.
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