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Cellina M, Cè M, Irmici G, Ascenti V, Caloro E, Bianchi L, Pellegrino G, D’Amico N, Papa S, Carrafiello G. Artificial Intelligence in Emergency Radiology: Where Are We Going? Diagnostics (Basel) 2022; 12:diagnostics12123223. [PMID: 36553230 PMCID: PMC9777804 DOI: 10.3390/diagnostics12123223] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2022] [Revised: 12/11/2022] [Accepted: 12/16/2022] [Indexed: 12/23/2022] Open
Abstract
Emergency Radiology is a unique branch of imaging, as rapidity in the diagnosis and management of different pathologies is essential to saving patients' lives. Artificial Intelligence (AI) has many potential applications in emergency radiology: firstly, image acquisition can be facilitated by reducing acquisition times through automatic positioning and minimizing artifacts with AI-based reconstruction systems to optimize image quality, even in critical patients; secondly, it enables an efficient workflow (AI algorithms integrated with RIS-PACS workflow), by analyzing the characteristics and images of patients, detecting high-priority examinations and patients with emergent critical findings. Different machine and deep learning algorithms have been trained for the automated detection of different types of emergency disorders (e.g., intracranial hemorrhage, bone fractures, pneumonia), to help radiologists to detect relevant findings. AI-based smart reporting, summarizing patients' clinical data, and analyzing the grading of the imaging abnormalities, can provide an objective indicator of the disease's severity, resulting in quick and optimized treatment planning. In this review, we provide an overview of the different AI tools available in emergency radiology, to keep radiologists up to date on the current technological evolution in this field.
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Affiliation(s)
- Michaela Cellina
- Radiology Department, Fatebenefratelli Hospital, ASST Fatebenefratelli Sacco, Milano, Piazza Principessa Clotilde 3, 20121 Milan, Italy
- Correspondence:
| | - Maurizio Cè
- Postgraduation School in Radiodiagnostics, Università degli Studi di Milano, Via Festa del Perdono, 7, 20122 Milan, Italy
| | - Giovanni Irmici
- Postgraduation School in Radiodiagnostics, Università degli Studi di Milano, Via Festa del Perdono, 7, 20122 Milan, Italy
| | - Velio Ascenti
- Postgraduation School in Radiodiagnostics, Università degli Studi di Milano, Via Festa del Perdono, 7, 20122 Milan, Italy
| | - Elena Caloro
- Postgraduation School in Radiodiagnostics, Università degli Studi di Milano, Via Festa del Perdono, 7, 20122 Milan, Italy
| | - Lorenzo Bianchi
- Postgraduation School in Radiodiagnostics, Università degli Studi di Milano, Via Festa del Perdono, 7, 20122 Milan, Italy
| | - Giuseppe Pellegrino
- Postgraduation School in Radiodiagnostics, Università degli Studi di Milano, Via Festa del Perdono, 7, 20122 Milan, Italy
| | - Natascha D’Amico
- Unit of Diagnostic Imaging and Stereotactic Radiosurgery, Centro Diagnostico Italiano, Via Saint Bon 20, 20147 Milan, Italy
| | - Sergio Papa
- Unit of Diagnostic Imaging and Stereotactic Radiosurgery, Centro Diagnostico Italiano, Via Saint Bon 20, 20147 Milan, Italy
| | - Gianpaolo Carrafiello
- Postgraduation School in Radiodiagnostics, Università degli Studi di Milano, Via Festa del Perdono, 7, 20122 Milan, Italy
- Radiology Department, Fondazione IRCCS Cà Granda, Policlinico di Milano Ospedale Maggiore, Via Sforza 35, 20122 Milan, Italy
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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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Cadavid-Navas M, Valdés-Giraldo D, Mejía-Toro DA, Correa-Cote JC, Morales-Uribe CH, Delgado-López CA. Resultados del manejo no operatorio en trauma hepático de los pacientes que se presentaron al servicio de urgencias del Hospital San Vicente Fundación, Medellín. REVISTA COLOMBIANA DE CIRUGÍA 2022. [DOI: 10.30944/20117582.1116] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Introducción. El hígado continúa siendo uno de los órganos más afectados en los pacientes con trauma. Su evaluación y manejo han cambiado sustancialmente con los avances tecnológicos en cuanto a diagnóstico y las técnicas de manejo menos invasivas. El objetivo de este estudio fue realizar un análisis de los resultados del manejo no operatorio del trauma hepático en cuanto a incidencia, eficacia, morbimortalidad, necesidad de intervención quirúrgica, tasa y factores relacionados con el fallo del manejo no operatorio.
Métodos. Se realizó un estudio descriptivo observacional retrospectivo, analizando pacientes con trauma hepático confirmado con tomografía o cirugía, durante un periodo de 72 meses, en el Hospital Universitario San Vicente Fundación, un centro de IV nivel de atención, en Medellín, Colombia.
Resultados. Se incluyeron 341 pacientes con trauma hepático, 224 por trauma penetrante y 117 por trauma cerrado. En trauma penetrante, 208 pacientes fueron llevados a cirugía inmediatamente, el resto fueron manejados de manera no operatoria, con una falla en el manejo en 20 pacientes. En trauma cerrado, 22 fueron llevados a cirugía inmediata y 95 sometidos a manejo no operatorio, con una falla en 9 pacientes. La mortalidad global fue de 9,7 % y la mortalidad relacionada al trauma hepático fue de 4,4 %. El grado del trauma, el índice de severidad del trauma y las lesiones abdominales no hepáticas no se consideraron factores de riesgo para la falla del manejo no operatorio.
Conclusiones. El manejo no operatorio continúa siendo una alternativa segura y efectiva para pacientes con trauma hepático, sobretodo en trauma cerrado. En trauma penetrante se debe realizar una adecuada selección de los pacientes.
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Hagiwara M, Iwata Y, Takahashi H, Imai K, Yokoo H, Ishitoya S, Ogata M, Matsuno N, Sumi Y, Furukawa H. Severe liver injury with traumatic cardiac arrest successfully treated by damage control surgery and transcatheter arterial embolization in the hybrid operating room: a case report. Surg Case Rep 2021; 7:234. [PMID: 34718909 PMCID: PMC8556852 DOI: 10.1186/s40792-021-01317-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2021] [Accepted: 10/19/2021] [Indexed: 11/10/2022] Open
Abstract
Background The damage control approach is known to reduce the mortality rate in severely injured patients and has now become a common practice. Transcatheter arterial embolization (TAE) has been shown to be useful with combining with damage control laparotomy in identifying and controlling active arterial hemorrhage. Hybrid operating room (OR) allows both damaged control surgery and TAE in the same location in minimal time. We report a case of a patient with three cardiac arrests who was saved by early intervention using damage control surgery (DCS) with interventional radiology (IVR) in the hybrid OR. Case presentation A 46-year-old woman was injured in a collision with a tree while snowboarding. She was eventually transported to hybrid operating room in our hospital with the diagnosis of significant liver laceration and hemorrhagic shock. Damage control surgery was performed with perihepatic packing (PHP) and TAE was conducted to stop active bleeding from right hepatic artery. She experienced 3 times of cardiopulmonary arrest, which was successfully resuscitated on each occasion. Although she had total of 3 times of laparotomy but tolerated well. She was discharged on day 82 of hospitalization and showed no neurological sequelae. Conclusion Saving the life of a patient with severe trauma requires a multidisciplinary approach with cooperation and early information sharing among trauma team members. Sharing treatment strategy with the trauma team and early intervention using DCS with IVR in the hybrid operating room could save the patient’s life.
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Affiliation(s)
- Masahiro Hagiwara
- Division of Hepato-Biliary-Pancreatic and Transplant Surgery, Department of Surgery, Asahikawa Medical University, 2-1, Midorigaoka-Higashi, Asahikawa, Hokkaido, Japan.
| | - Yoshihiro Iwata
- Division of Hepato-Biliary-Pancreatic and Transplant Surgery, Department of Surgery, Asahikawa Medical University, 2-1, Midorigaoka-Higashi, Asahikawa, Hokkaido, Japan
| | - Hiroyuki Takahashi
- Division of Hepato-Biliary-Pancreatic and Transplant Surgery, Department of Surgery, Asahikawa Medical University, 2-1, Midorigaoka-Higashi, Asahikawa, Hokkaido, Japan
| | - Koji Imai
- Division of Hepato-Biliary-Pancreatic and Transplant Surgery, Department of Surgery, Asahikawa Medical University, 2-1, Midorigaoka-Higashi, Asahikawa, Hokkaido, Japan
| | - Hideki Yokoo
- Division of Hepato-Biliary-Pancreatic and Transplant Surgery, Department of Surgery, Asahikawa Medical University, 2-1, Midorigaoka-Higashi, Asahikawa, Hokkaido, Japan
| | - Shunta Ishitoya
- Department of Radiology, Asahikawa Medical University, Asahikawa, Japan
| | - Miki Ogata
- Department of Radiology, Asahikawa Medical University, Asahikawa, Japan
| | - Naoto Matsuno
- Division of Hepato-Biliary-Pancreatic and Transplant Surgery, Department of Surgery, Asahikawa Medical University, 2-1, Midorigaoka-Higashi, Asahikawa, Hokkaido, Japan
| | - Yasuo Sumi
- Division of Gastrointestinal Surgery, Department of Surgery, Asahikawa Medical University, Asahikawa, Japan
| | - Hiroyuki Furukawa
- Division of Hepato-Biliary-Pancreatic and Transplant Surgery, Department of Surgery, Asahikawa Medical University, 2-1, Midorigaoka-Higashi, Asahikawa, Hokkaido, Japan
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Tamura S, Maruhashi T, Kashimi F, Kurihara Y, Masuda T, Hanajima T, Kataoka Y, Asari Y. Transcatheter arterial embolization for severe blunt liver injury in hemodynamically unstable patients: a 15-year retrospective study. Scand J Trauma Resusc Emerg Med 2021; 29:66. [PMID: 34256826 PMCID: PMC8278697 DOI: 10.1186/s13049-021-00881-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2020] [Accepted: 04/21/2021] [Indexed: 11/18/2022] Open
Abstract
Background Transcatheter arterial embolization (TAE) is the first-line nonsurgical treatment for severe blunt liver injury in patients, whereas operative management (OM) is recommended for hemodynamically unstable patients. This study investigated the comparative efficacy of TAE in hemodynamically unstable patients who responded to initial infusion therapy. Methods This retrospective study enrolled patients with severe blunt liver injuries, which were of grades III–V according to the American Association for the Surgery of Trauma Organ Injury Scale (OIS). Patients who responded to initial infusion therapy underwent computed tomography to determine the treatment plan. A shock index > 1, despite undergoing initial infusion therapy, was defined as hemodynamic instability. We compared the clinical outcomes and mortality rates between patients who received OM and those who underwent TAE. Results Sixty-two patients were included (eight and 54 who underwent OM and TAE, respectively; mean injury severity score, 26.6). The overall in-hospital mortality rate was 6% (13% OM vs. 6% TAE, p = 0.50), and the hemodynamic instability was 35% (88% OM vs. 28% TAE, p < 0.01). Hemodynamically unstable patients who underwent TAE had 7% in-hospital mortality and 7% clinical failure. Logistic regression analysis showed that the treatment choice was not a predictor of outcome, whereas hemodynamic instability was an independent predictor of intensive care unit stay ≥7 days (odds ratio [OR], 3.80; p = 0.05) and massive blood transfusion (OR, 7.25; p = 0.01); OIS grades IV–V were predictors of complications (OR, 6.61; p < 0.01). Conclusions TAE in hemodynamically unstable patients who responded to initial infusion therapy to some extent has acceptable in-hospital mortality and clinical failure rates. Hemodynamic instability and OIS, but not treatment choice, affected the clinical outcomes.
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Affiliation(s)
- Satoshi Tamura
- Department of Emergency and Critical Care Medicine, Kitasato University School of Medicine, 1-15-1, Kitasato, Minami-ku, Sagamihara, Kanagawa, 252-0374, Japan.
| | - Takaaki Maruhashi
- Department of Emergency and Critical Care Medicine, Kitasato University School of Medicine, 1-15-1, Kitasato, Minami-ku, Sagamihara, Kanagawa, 252-0374, Japan
| | - Fumie Kashimi
- Department of Emergency and Critical Care Medicine, Kitasato University School of Medicine, 1-15-1, Kitasato, Minami-ku, Sagamihara, Kanagawa, 252-0374, Japan
| | - Yutaro Kurihara
- Department of Emergency and Critical Care Medicine, Kitasato University School of Medicine, 1-15-1, Kitasato, Minami-ku, Sagamihara, Kanagawa, 252-0374, Japan
| | - Tomonari Masuda
- Department of Emergency and Critical Care Medicine, Kitasato University School of Medicine, 1-15-1, Kitasato, Minami-ku, Sagamihara, Kanagawa, 252-0374, Japan
| | - Tasuku Hanajima
- Department of Emergency and Critical Care Medicine, Kitasato University School of Medicine, 1-15-1, Kitasato, Minami-ku, Sagamihara, Kanagawa, 252-0374, Japan
| | - Yuichi Kataoka
- Department of Emergency and Critical Care Medicine, Kitasato University School of Medicine, 1-15-1, Kitasato, Minami-ku, Sagamihara, Kanagawa, 252-0374, Japan
| | - Yasushi Asari
- Department of Emergency and Critical Care Medicine, Kitasato University School of Medicine, 1-15-1, Kitasato, Minami-ku, Sagamihara, Kanagawa, 252-0374, Japan
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Dreizin D, Chen T, Liang Y, Zhou Y, Paes F, Wang Y, Yuille AL, Roth P, Champ K, Li G, McLenithan A, Morrison JJ. Added value of deep learning-based liver parenchymal CT volumetry for predicting major arterial injury after blunt hepatic trauma: a decision tree analysis. Abdom Radiol (NY) 2021; 46:2556-2566. [PMID: 33469691 PMCID: PMC8205942 DOI: 10.1007/s00261-020-02892-x] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2020] [Revised: 11/30/2020] [Accepted: 12/04/2020] [Indexed: 12/14/2022]
Abstract
PURPOSE In patients presenting with blunt hepatic injury (BHI), the utility of CT for triage to hepatic angiography remains uncertain since simple binary assessment of contrast extravasation (CE) as being present or absent has only modest accuracy for major arterial injury on digital subtraction angiography (DSA). American Association for the Surgery of Trauma (AAST) liver injury grading is coarse and subjective, with limited diagnostic utility in this setting. Volumetric measurements of hepatic injury burden could improve prediction. We hypothesized that in a cohort of patients that underwent catheter-directed hepatic angiography following admission trauma CT, a deep learning quantitative visualization method that calculates % liver parenchymal disruption (the LPD index, or LPDI) would add value to CE assessment for prediction of major hepatic arterial injury (MHAI). METHODS This retrospective study included adult patients with BHI between 1/1/2008 and 5/1/2017 from two institutions that underwent admission trauma CT prior to hepatic angiography (n = 73). Presence (n = 41) or absence (n = 32) of MHAI (pseudoaneurysm, AVF, or active contrast extravasation on DSA) served as the outcome. Voxelwise measurements of liver laceration were derived using an existing multiscale deep learning algorithm trained on manually labeled data using cross-validation with a 75-25% split in four unseen folds. Liver volume was derived using a pre-trained whole liver segmentation algorithm. LPDI was automatically calculated for each patient by determining the percentage of liver involved by laceration. Classification and regression tree (CART) analyses were performed using a combination of automated LPDI measurements and either manually segmented CE volumes, or CE as a binary sign. Performance metrics for the decision rules were compared for significant differences with binary CE alone (the current standard of care for predicting MHAI), and the AAST grade. RESULTS 36% of patients (n = 26) had contrast extravasation on CT. Median [Q1-Q3] automated LPDI was 4.0% [1.0-12.1%]. 41/73 (56%) of patients had MHAI. A decision tree based on auto-LPDI and volumetric CE measurements (CEvol) had the highest accuracy (0.84, 95% CI 0.73-0.91) with significant improvement over binary CE assessment (0.68, 95% CI 0.57-0.79; p = 0.01). AAST grades at different cut-offs performed poorly for predicting MHAI, with accuracies ranging from 0.44-0.63. Decision tree analysis suggests an auto-LPDI cut-off of ≥ 12% for minimizing false negative CT exams when CE is absent or diminutive. CONCLUSION Current CT imaging paradigms are coarse, subjective, and limited for predicting which BHIs are most likely to benefit from AE. LPDI, automated using deep learning methods, may improve objective personalized triage of BHI patients to angiography at the point of care.
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Affiliation(s)
- David Dreizin
- Emergency and Trauma Imaging, Department of Diagnostic Radiology and Nuclear Medicine, R Adams Cowley Shock Trauma Center, University of Maryland School of Medicine, 655 W Baltimore St, Baltimore, MD, 21201, USA.
| | - Tina Chen
- Department of Diagnostic Radiology and Nuclear Medicine, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Yuanyuan Liang
- Department of Epidemiology and Public Health, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Yuyin Zhou
- Department of Computer Science, Center for Cognition Vision and Learning, Johns Hopkins University, Baltimore, MD, USA
| | - Fabio Paes
- Emergency and Trauma Imaging, Department of Radiology, University of Miami - Miller School of Medicine, Jackson Memorial Hospital - Ryder Trauma Center, Miami, USA
| | - Yan Wang
- Department of Computer Science, Center for Cognition Vision and Learning, Johns Hopkins University, Baltimore, MD, USA
| | - Alan L Yuille
- Department of Computer Science, Center for Cognition Vision and Learning, Johns Hopkins University, Baltimore, MD, USA
| | - Patrick Roth
- Emergency and Trauma Imaging, Department of Radiology, University of Miami - Miller School of Medicine, Jackson Memorial Hospital - Ryder Trauma Center, Miami, USA
| | - Kathryn Champ
- Department of Diagnostic Radiology and Nuclear Medicine, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Guang Li
- Department of Diagnostic Radiology and Nuclear Medicine, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Ashley McLenithan
- R Adams Cowley Shock Trauma Center, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Jonathan J Morrison
- Vascular Surgery, R Adams Cowley Shock Trauma Center, University of Maryland School of Medicine, Baltimore, MD, USA
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Al-Thani H, Abdelrahman H, Barah A, Asim M, El-Menyar A. Utility of Angioembolization in Patients with Abdominal and Pelvic Traumatic Bleeding: Descriptive Observational Analysis from a Level 1 Trauma Center. Ther Clin Risk Manag 2021; 17:333-343. [PMID: 33907407 PMCID: PMC8064722 DOI: 10.2147/tcrm.s303518] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2021] [Accepted: 03/29/2021] [Indexed: 12/03/2022] Open
Abstract
Background Massive bleeding is a major preventable cause of early death in trauma. It often requires surgical and/or endovascular intervention. We aimed to describe the utilization of angioembolization in patients with abdominal and pelvic traumatic bleeding at a level 1 trauma center. Methods We conducted a retrospective analysis for all trauma patients who underwent angioembolization post-traumatic bleeding between January 2012 and April 2018. Patients’ data and details of injuries, angiography procedures and outcomes were extracted from the Qatar national trauma registry. Results A total of 175 trauma patients underwent angioembolization during the study period (103 for solid organ injury, 51 for pelvic injury and 21 for other injuries). The majority were young males. The main cause of injury was blunt trauma in 95.4% of the patients. The most common indication of angioembolization was evident active bleeding on the initial CT scan (contrast pool or blushes). Blood transfusion was needed in two-third of patients. The hepatic injury cases had higher ISS, higher shock index and more blood transfusion. Absorbable particles (Gelfoam) were the most commonly used embolic material. The overall technical and clinical success rate was 93.7% and 95%, respectively, with low rebleeding and complication rates. The hospital and ICU length of stay were 13 and 6 days, respectively. The median injury to intervention time was 320 min while hospital arrival to intervention time was 274 min. The median follow-up time was 215 days. The overall cohort mortality was 15%. Conclusion Angioembolization is an effective intervention to stop bleeding and support nonoperative management for both solid organ injuries and pelvic trauma. It has a high success rate with a careful selection and proper implementation.
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Affiliation(s)
- Hassan Al-Thani
- Department of Surgery, Trauma&Vascular Surgery, Hamad General Hospital, Doha, Qatar
| | - Husham Abdelrahman
- Department of Surgery, Trauma Surgery, Hamad General Hospital, Doha, Qatar
| | - Ali Barah
- Department of Radiology, Hamad General Hospital, Doha, Qatar
| | - Mohammad Asim
- Department of Surgery, Clinical Research, Trauma & Vascular Surgery, Hamad General Hospital, Doha, Qatar
| | - Ayman El-Menyar
- Department of Surgery, Clinical Research, Trauma & Vascular Surgery, Hamad General Hospital, Doha, Qatar.,Department of Clinical Medicine, Weill Cornell Medical School, Doha, Qatar
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Kumar S, Gupta A, Sagar S, Bagaria D, Kumar A, Choudhary N, Kumar V, Ghoshal S, Alam J, Agarwal H, Gammangatti S, Kumar A, Soni KD, Agarwal R, Gunjaganvi M, Joshi M, Saurabh G, Banerjee N, Kumar A, Rattan A, Bakhshi GD, Jain S, Shah S, Sharma P, Kalangutkar A, Chatterjee S, Sharma N, Noronha W, Mohan LN, Singh V, Gupta R, Misra S, Jain A, Dharap S, Mohan R, Priyadarshini P, Tandon M, Mishra B, Jain V, Singhal M, Meena YK, Sharma B, Garg PK, Dhagat P, Kumar S, Kumar S, Misra MC. Management of Blunt Solid Organ Injuries: the Indian Society for Trauma and Acute Care (ISTAC) Consensus Guidelines. Indian J Surg 2021. [DOI: 10.1007/s12262-021-02820-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
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Lee RK, Gallagher JJ, Ejike JC, Hunt L. Intra-abdominal Hypertension and the Open Abdomen: Nursing Guidelines From the Abdominal Compartment Society. Crit Care Nurse 2020; 40:13-26. [PMID: 32006038 DOI: 10.4037/ccn2020772] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
Abstract
Intra-abdominal hypertension has been identified as an independent risk factor for death in critically ill patients. Known risk factors for intra-abdominal hypertension indicate that intra-abdominal pressures should be measured and monitored. The Abdominal Compartment Society has identified medical and surgical interventions to relieve intra-abdominal hypertension or to manage the open abdomen if abdominal compartment syndrome occurs. The purpose of this article is to describe assessments and interventions for managing intra-abdominal hypertension and open abdomen that are within the scope of practice for direct-care nurses. These guidelines provide direction to critical care nurses caring for these patients.
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Affiliation(s)
- Rosemary K Lee
- Rosemary K. Lee is an acute care nurse practitioner and clinical nurse specialist at Baptist Health South Florida, Coral Gables, Florida
| | - John J Gallagher
- John J. Gallagher is a clinical nurse specialist and trauma program coordinator, Penn Presbyterian Medical Center, Philadelphia, Pennsylvania
| | - Janeth Chiaka Ejike
- Janeth Chiaka Ejike is an associate professor of pediatrics, pediatric critical care medicine practitioner, and Program Director of the Pediatric Critical Care Medicine Fellowship at Loma Linda University Children's Hospital, Loma Linda, California
| | - Leanne Hunt
- Leanne Hunt is a senior lecturer at Western Sydney University and a registered nurse at Liverpool Hospital, Sydney, Australia
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Lada NE, Gupta A, Anderson SW, Dinh DC, Campbell JM, Maggi A, Gandhi J, Qureshi MM, Wing H, Schulze R, LeBedis CA. Liver trauma: hepatic vascular injury on computed tomography as a predictor of patient outcome. Eur Radiol 2020; 31:3375-3382. [PMID: 33125557 DOI: 10.1007/s00330-020-07373-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2020] [Revised: 08/12/2020] [Accepted: 10/05/2020] [Indexed: 11/25/2022]
Abstract
OBJECTIVES To evaluate hepatic vascular injury (HVI) on CT in blunt and penetrating trauma and assess its relationship to patient management and outcome. METHOD AND MATERIALS This retrospective study was IRB approved and HIPAA compliant. Informed consent was waived. Included were patients ≥ 16 years old who sustained blunt or penetrating trauma with liver laceration seen on a CT performed at our institution within 24 h of presentation over the course of 10 years and 6 months (August 2007-February 2018). During this interval, 171 patients met inclusion criteria (123 males, 48 females; mean age 34; age range 17-80 years old). Presence of HVI was evaluated and liver injury was graded in a blinded fashion by two radiologists using the 1994 and 2018 American Association for the Surgery of Trauma (AAST) liver injury scales. Hospital length of stay and treatment (angioembolization or operative) were recorded from the electronic medical record. Multivariate linear regressions were used to determine our variables' impact on the length of stay, and logistic regressions were used for categorical outcomes. RESULTS Of the included liver trauma patients, 25% had HVI. Patients with HVI had a 3.2-day longer length of hospital stay on average and had a 40.3-fold greater odds of getting angioembolization compared to those without. Patients with high-grade liver injury (AAST grades IV-V, 2018 criteria) had a 3.2-fold greater odds of failing non-operative management and a 14.3-fold greater odds of angioembolization compared to those without. CONCLUSION HVI in liver trauma is common and is predictive of patient outcome and management. KEY POINTS • Hepatic vascular injury occurs commonly (25%) with liver trauma. • Hepatic vascular injury is associated with increased length of hospital stay and angioembolization. • High-grade liver injury is associated with failure of non-operative management and with angioembolization.
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Affiliation(s)
- Nicholas Ellerman Lada
- Department of Radiology, Boston Medical Center, Boston University School of Medicine, 820 Harrison Ave, Boston, MA, 02118, USA.
| | - Avneesh Gupta
- Department of Radiology, Boston Medical Center, Boston University School of Medicine, 820 Harrison Ave, Boston, MA, 02118, USA
| | - Stephan W Anderson
- Department of Radiology, Boston Medical Center, Boston University School of Medicine, 820 Harrison Ave, Boston, MA, 02118, USA
| | - Diana C Dinh
- Department of Radiology, Boston Medical Center, Boston University School of Medicine, 820 Harrison Ave, Boston, MA, 02118, USA
| | - John M Campbell
- Boston University, School of Medicine, 72 East Concord St., Boston, MA, 02118, USA
| | - Alec Maggi
- Boston University, School of Medicine, 72 East Concord St., Boston, MA, 02118, USA
| | - Jasmine Gandhi
- Boston University, School of Medicine, 72 East Concord St., Boston, MA, 02118, USA
| | - Muhammad Mustafa Qureshi
- Department of Radiology, Boston Medical Center, Boston University School of Medicine, 820 Harrison Ave, Boston, MA, 02118, USA
| | - Heidi Wing
- Department of Surgery, Boston Medical Center, Boston University School of Medicine, 72 East Concord Street, Boston, MA, 02118, USA
| | - Robert Schulze
- Department of Surgery, Boston Medical Center, Boston University School of Medicine, 72 East Concord Street, Boston, MA, 02118, USA
| | - Christina A LeBedis
- Department of Radiology, Boston Medical Center, Boston University School of Medicine, 820 Harrison Ave, Boston, MA, 02118, USA
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11
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Zargaran D, Zargaran A, Khan M. Systematic Review of the Management of Retro-Hepatic Inferior Vena Cava Injuries. Open Access Emerg Med 2020; 12:163-171. [PMID: 32617024 PMCID: PMC7326178 DOI: 10.2147/oaem.s247380] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2020] [Accepted: 04/19/2020] [Indexed: 11/23/2022] Open
Abstract
Background Retro-hepatic inferior vena cava (RHIVC) injuries resulting from blunt or penetrating abdominal trauma are rare but devastating events that remain a considerable challenge to even the most experienced doctors, which continue to carry a considerable mortality. Aim To establish a better understanding of the management of RHIVC injuries and to identify any adjuncts or operative methods that were associated with an increased survival. Methods A systematic review of the MEDLINE database was conducted using Medical Search Headings and exploded keywords and phrases. Studies were screened and subjected to inclusion/exclusion criteria. Data were extracted in a methodical manner collecting population demographics, morbidity, mortality and operative intervention, where provided. Operative strategies were compared and discussed. Results An initial search identified 483 articles. Following duplicate removal and abstract screening, 85 full-text articles were assessed with 25 meeting the desired criteria and were, therefore, included in the systematic review. Key operative strategies and complications were identified and discussed. Conclusion The wide variety of operative interventions in the management of RHIVC liver injuries described attest to the increased efforts to improve outcomes. The overall improvement in mortality can be noted since the earlier descriptions reported mortality approaching 100% compared to the 52% reported in this review. An algorithm has been proposed based on these findings and our experiences for the management of RHIVC injuries.
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Affiliation(s)
- David Zargaran
- Department of Medicine, Imperial College London, London, UK
| | | | - Mansoor Khan
- Brighton and Sussex University Hospitals, Brighton, UK
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12
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AbuAleid LH, Elshaar K, Alhazmi AA, Sherbini MA, Albohiri K. Intrahepatic pseudoaneurysm following penetrating abdominal injury: Surgical and endovascular management of 2 complicated cases. Int J Surg Case Rep 2020; 71:250-256. [PMID: 32492639 PMCID: PMC7264984 DOI: 10.1016/j.ijscr.2020.05.017] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2020] [Revised: 05/04/2020] [Accepted: 05/04/2020] [Indexed: 12/26/2022] Open
Abstract
INTRODUCTION Post-traumatic pseudoaneurysm of the hepatic artery is a rare complication of abdominal injury. Prompt intervention is essential to avoid a life-threatening hemorrhage. We report two complicated cases of intrahepatic pseudoaneurysm (IHPA). PRESENTATION OF CASES Case 1: A victim of a bomb blast with thoracoabdominal injury presented in hypovolemic shock. Emergency laparotomy revealed actively bleeding liver lacerations, which had been successfully controlled with perihepatic packing. After 72 h, computed tomography (CT) of the abdomen showed a 3 cm × 1.8 cm IHPA of the left hepatic artery, which was treated with endovascular microcoils embolization. Postoperatively, the patient developed bile leakage and biliopleural fistula, which were managed conservatively. Case 2: A patient suffered a shotgun injury to the abdomen. In laparotomy, a grade III liver laceration was noted. The bleeding was controlled with perihepatic packing. The packs were removed 48 h later. Ten days postoperatively, the patient developed severe abdominal pain with shock, CT of the abdomen showed; 24 cm × 13 cm × 8 cm subcapsular liver hematoma. Superselective hepatic angiography showed a 1-cm IHPA of the right hepatic artery. The entry and exit points of the aneurysm were successfully embolized with two microcoils. No complications related to angioembolizaion were encountered. DISCUSSION IHPA following bomb blast and shotgun injury is rarely reported. Timely diagnosis is crucial. CONCLUSION We advise to keep in mind the possibility of IHPA, when dealing with high-grade liver injury. CT is recommended before removal of perihepatic packs, as it may pick up a life-threatening pseudoaneurysm.
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Affiliation(s)
- Laila H AbuAleid
- Department of General Surgery, King Fahad Central Hospital, Jazan, Saudi Arabia.
| | - Khaled Elshaar
- Department of General Surgery, King Fahad Central Hospital, Jazan, Saudi Arabia
| | - Almoaiad A Alhazmi
- Department of Interventional Radiology, King Fahad Central Hospital, Jazan, Saudi Arabia
| | | | - Khalid Albohiri
- Department of Thoracic Surgery, King Fahad Central Hospital, Jazan, Saudi Arabia
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13
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Alexander LF, Hanna TN, LeGout JD, Roda MS, Cernigliaro JG, Mittal PK, Harri PA. Multidetector CT Findings in the Abdomen and Pelvis after Damage Control Surgery for Acute Traumatic Injuries. Radiographics 2020; 39:1183-1202. [PMID: 31283454 DOI: 10.1148/rg.2019180153] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
After experiencing blunt or penetrating trauma, patients in unstable condition who are more likely to die of uncorrected shock than of incomplete injury repairs undergo emergency limited exploratory laparotomy, which is also known as damage control surgery (DCS). This surgery is part of a series of resuscitation steps, with the goal of stabilizing the patient's condition, with rapid surgical control of hemorrhage followed by supportive measures in the intensive care unit before definitive repair of injuries. These patients often are imaged with multidetector CT within 24-48 hours of the initial surgery. Knowledge of this treatment plan is critical to CT interpretation, because there are anatomic derangements and foreign bodies that would not be present in patients undergoing surgery for other reasons. Patients may have injuries beyond the surgical field that are only identified at imaging, which can alter the care plan. Abnormalities related to the resuscitation period such as the CT hypoperfusion complex and ongoing hemorrhage can be recognized at CT. Familiarity with these imaging and clinical findings is important, because they can be seen not only in trauma patients after DCS but also in other patients in the critical care setting. The interpretation of imaging studies can be helped by an understanding of the diagnostic challenges of grading organ injuries with surgical materials in place and the awareness of potential artifacts on images in these patients. Online supplemental material is available for this article. ©RSNA, 2019 See discussion on this article by LeBedis .
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Affiliation(s)
- Lauren F Alexander
- From the Department of Radiology, Mayo Clinic, 4500 San Pablo Rd, Jacksonville, FL 32224 (L.F.A., J.D.L., J.G.C.); Department of Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, Ga (T.N.H., P.A.H.); Department of Radiology, University of Mississippi Medical Center, Jackson, Miss (M.S.R.); and Department of Radiology and Imaging, Medical College of Georgia, Augusta, Ga (P.K.M.)
| | - Tarek N Hanna
- From the Department of Radiology, Mayo Clinic, 4500 San Pablo Rd, Jacksonville, FL 32224 (L.F.A., J.D.L., J.G.C.); Department of Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, Ga (T.N.H., P.A.H.); Department of Radiology, University of Mississippi Medical Center, Jackson, Miss (M.S.R.); and Department of Radiology and Imaging, Medical College of Georgia, Augusta, Ga (P.K.M.)
| | - Jordan D LeGout
- From the Department of Radiology, Mayo Clinic, 4500 San Pablo Rd, Jacksonville, FL 32224 (L.F.A., J.D.L., J.G.C.); Department of Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, Ga (T.N.H., P.A.H.); Department of Radiology, University of Mississippi Medical Center, Jackson, Miss (M.S.R.); and Department of Radiology and Imaging, Medical College of Georgia, Augusta, Ga (P.K.M.)
| | - Manohar S Roda
- From the Department of Radiology, Mayo Clinic, 4500 San Pablo Rd, Jacksonville, FL 32224 (L.F.A., J.D.L., J.G.C.); Department of Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, Ga (T.N.H., P.A.H.); Department of Radiology, University of Mississippi Medical Center, Jackson, Miss (M.S.R.); and Department of Radiology and Imaging, Medical College of Georgia, Augusta, Ga (P.K.M.)
| | - Joseph G Cernigliaro
- From the Department of Radiology, Mayo Clinic, 4500 San Pablo Rd, Jacksonville, FL 32224 (L.F.A., J.D.L., J.G.C.); Department of Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, Ga (T.N.H., P.A.H.); Department of Radiology, University of Mississippi Medical Center, Jackson, Miss (M.S.R.); and Department of Radiology and Imaging, Medical College of Georgia, Augusta, Ga (P.K.M.)
| | - Pardeep K Mittal
- From the Department of Radiology, Mayo Clinic, 4500 San Pablo Rd, Jacksonville, FL 32224 (L.F.A., J.D.L., J.G.C.); Department of Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, Ga (T.N.H., P.A.H.); Department of Radiology, University of Mississippi Medical Center, Jackson, Miss (M.S.R.); and Department of Radiology and Imaging, Medical College of Georgia, Augusta, Ga (P.K.M.)
| | - Peter A Harri
- From the Department of Radiology, Mayo Clinic, 4500 San Pablo Rd, Jacksonville, FL 32224 (L.F.A., J.D.L., J.G.C.); Department of Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, Ga (T.N.H., P.A.H.); Department of Radiology, University of Mississippi Medical Center, Jackson, Miss (M.S.R.); and Department of Radiology and Imaging, Medical College of Georgia, Augusta, Ga (P.K.M.)
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14
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Coccolini F, Coimbra R, Ordonez C, Kluger Y, Vega F, Moore EE, Biffl W, Peitzman A, Horer T, Abu-Zidan FM, Sartelli M, Fraga GP, Cicuttin E, Ansaloni L, Parra MW, Millán M, DeAngelis N, Inaba K, Velmahos G, Maier R, Khokha V, Sakakushev B, Augustin G, di Saverio S, Pikoulis E, Chirica M, Reva V, Leppaniemi A, Manchev V, Chiarugi M, Damaskos D, Weber D, Parry N, Demetrashvili Z, Civil I, Napolitano L, Corbella D, Catena F. Liver trauma: WSES 2020 guidelines. World J Emerg Surg 2020; 15:24. [PMID: 32228707 PMCID: PMC7106618 DOI: 10.1186/s13017-020-00302-7] [Citation(s) in RCA: 123] [Impact Index Per Article: 30.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2020] [Accepted: 03/06/2020] [Indexed: 02/06/2023] Open
Abstract
Liver injuries represent one of the most frequent life-threatening injuries in trauma patients. In determining the optimal management strategy, the anatomic injury, the hemodynamic status, and the associated injuries should be taken into consideration. Liver trauma approach may require non-operative or operative management with the intent to restore the homeostasis and the normal physiology. The management of liver trauma should be multidisciplinary including trauma surgeons, interventional radiologists, and emergency and ICU physicians. The aim of this paper is to present the World Society of Emergency Surgery (WSES) liver trauma management guidelines.
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Affiliation(s)
- Federico Coccolini
- General, Emergency and Trauma Surgery Department, Pisa University Hospital, Via Paradisia 1, 56100, Pisa, Italy.
| | - Raul Coimbra
- Riverside University Health System, CECORC Research Center, Loma Linda University, Loma Linda, USA
| | - Carlos Ordonez
- Division of Trauma and Acute Care Surgery, Fundación Valle del Lili, Cali, Colombia
| | - Yoram Kluger
- Division of General Surgery, Rambam Health Care Campus Haifa, Haifa, Israel
| | - Felipe Vega
- Department of Surgery, Hospital Angeles Lomas, Huixquilucan, Mexico
| | | | - Walt Biffl
- Trauma Surgery Department, Scripps Memorial Hospital La Jolla, San Diego, CA, USA
| | - Andrew Peitzman
- Surgery Department, University of Pittsburgh, Pittsburgh, PA, USA
| | - Tal Horer
- Department of Cardiothoracic and Vascular Surgery, Örebro University Hospital, Örebro University, Örebro, Sweden.,Department of Surgery, Örebro University Hospital, Örebro University, Örebro, Sweden
| | - Fikri M Abu-Zidan
- Department of Surgery, College of Medicine and Health Sciences, UAE University, Al-Ain, United Arab Emirates
| | - Massimo Sartelli
- General and Emergency Surgery, Macerata Hospital, Macerata, Italy
| | - Gustavo P Fraga
- Trauma/Acute Care Surgery & Surgical Critical Care, University of Campinas, Campinas, Brazil
| | - Enrico Cicuttin
- General, Emergency and Trauma Surgery Department, Pisa University Hospital, Via Paradisia 1, 56100, Pisa, Italy
| | - Luca Ansaloni
- General, Emergency and Trauma Surgery Department, Bufalini Hospital, Cesena, Italy
| | - Michael W Parra
- Department of Trauma Critical Care, Broward General Level I Trauma Center, Fort Lauderdale, FL, USA
| | - Mauricio Millán
- Division of Trauma and Acute Care Surgery, Fundación Valle del Lili, Cali, Colombia
| | - Nicola DeAngelis
- Unit of Digestive Surgery, HPB Surgery and Liver Transplant, Henri Mondor Hospital, Créteil, France
| | - Kenji Inaba
- General and Trauma Surgery, LAC+USC Medical Center, Los Angeles, CA, USA
| | - George Velmahos
- General and Emergency Surgery, Massachusetts General Hospital, Boston, MA, USA
| | - Ron Maier
- Department of Surgery, Harborview Medical Centre, Seattle, USA
| | - Vladimir Khokha
- General Surgery Department, Mozir City Hospital, Mozir, Belarus
| | - Boris Sakakushev
- General Surgery Department, Medical University, University Hospital St George, Plovdiv, Bulgaria
| | - Goran Augustin
- Department of Surgery, Zagreb University Hospital Centre and School of Medicine, University of Zagreb, Zagreb, Croatia
| | - Salomone di Saverio
- General and Trauma Surgery Addenbrooke's Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - Emanuil Pikoulis
- 3rd Department of Surgery, Attiko Hospital, National & Kapodistrian University of Athens, Athens, Greece
| | - Mircea Chirica
- Chirurgie Digestive, CHUGA-CHU Grenoble Alpes, Grenoble, France
| | - Viktor Reva
- General and Emergency Surgery, Sergei Kirov Military Academy, Saint Petersburg, Russia
| | - Ari Leppaniemi
- General Surgery Department, Mehilati Hospital, Helsinki, Finland
| | - Vassil Manchev
- General and Trauma Surgery Department, Pietermaritzburg Hospital, Pietermaritzburg, South Africa
| | - Massimo Chiarugi
- General, Emergency and Trauma Surgery Department, Pisa University Hospital, Via Paradisia 1, 56100, Pisa, Italy
| | | | - Dieter Weber
- Department of General Surgery, Royal Perth Hospital, Perth, Australia
| | - Neil Parry
- General and Trauma Surgery Department, London Health Sciences Centre, Victoria Hospital, London, ON, Canada
| | | | - Ian Civil
- Trauma Surgery, Auckland University Hospital, Auckland, New Zealand
| | - Lena Napolitano
- Division of Acute Care Surgery, University of Michigan Health System, Ann Arbor, MI, USA
| | | | - Fausto Catena
- Emergency and Trauma Surgery, Maggiore Hospital, Parma, Italy
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15
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Gilyard S, Shinn K, Nezami N, Findeiss LK, Dariushnia S, Grant AA, Hawkins CM, Peters GL, Majdalany BS, Newsome J, Bercu ZL, Kokabi N. Contemporary Management of Hepatic Trauma: What IRs Need to Know. Semin Intervent Radiol 2020; 37:35-43. [PMID: 32139969 DOI: 10.1055/s-0039-3401838] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Trauma remains one of the leading causes of death in the United States in patients younger than 45 years. Blunt trauma is most commonly a result of high-speed motor vehicular collisions or high-level fall. The liver and spleen are the most commonly injured organs, with the liver being the most commonly injured organ in adults and the spleen being the most affected in pediatric blunt trauma. Liver injuries incur a high level of morbidity and mortality mostly secondary to hemorrhage. Over the past 20 years, angiographic intervention has become a mainstay of treatment of hepatic trauma. As there is an increasing need for the interventional radiologists to embolize active hemorrhage in the setting of blunt and penetrating hepatic trauma, this article aims to review the current level of evidence and contemporary management of hepatic trauma from the perspective of interventional radiologists. Embolization techniques and associated outcome and complications are also reviewed.
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Affiliation(s)
- Shenise Gilyard
- Division of Interventional Radiology and Image-Guided Medicine, Department of Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, Georgia
| | - Kaitlin Shinn
- Department of Medical Education, Emory University School of Medicine, Atlanta, Georgia
| | - Nariman Nezami
- Division of Vascular and Interventional Radiology, Department of Radiology and Radiological Science, Johns Hopkins School of Medicine, Baltimore, Maryland
| | - Laura K Findeiss
- Division of Interventional Radiology and Image-Guided Medicine, Department of Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, Georgia
| | - Sean Dariushnia
- Division of Interventional Radiology and Image-Guided Medicine, Department of Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, Georgia
| | - April A Grant
- Division of Trauma/Surgical Critical Care, Department of Surgery, Emory University School of Medicine, Atlanta, Georgia
| | - C Matthew Hawkins
- Division of Interventional Radiology and Image-Guided Medicine, Department of Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, Georgia
| | - Gail L Peters
- Division of Interventional Radiology and Image-Guided Medicine, Department of Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, Georgia
| | - Bill S Majdalany
- Division of Interventional Radiology and Image-Guided Medicine, Department of Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, Georgia
| | - Janice Newsome
- Division of Interventional Radiology and Image-Guided Medicine, Department of Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, Georgia
| | - Zachary L Bercu
- Division of Interventional Radiology and Image-Guided Medicine, Department of Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, Georgia
| | - Nima Kokabi
- Division of Interventional Radiology and Image-Guided Medicine, Department of Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, Georgia
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16
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Yu HH, Won YD, Lee SL, Ku YM, Song SW. Multidetector CT Findings of Solid Organ Injury Based on 2018 Updated American Association for the Surgery of Trauma Organ Injury Scaling System. JOURNAL OF THE KOREAN SOCIETY OF RADIOLOGY 2020; 81:1348-1363. [PMID: 36237708 PMCID: PMC9431845 DOI: 10.3348/jksr.2020.0033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/02/2020] [Revised: 03/17/2020] [Accepted: 03/31/2020] [Indexed: 11/16/2022]
Abstract
2018년에 새롭게 개정된 장기 손상척도는 이전 미국외상수술협회의 응급수술분류체계와 유사한 형식을 가지며, 고형장기 손상의 등급을 지정하는 기준을 영상(imaging), 수술(operative), 병리(pathologic) 세 가지 세트로 나누어 분류하였다. 2018년 개정에서 가장 중요한 변화는 거짓동맥류와 동정맥 누공을 포함한 혈관 손상의 다중검출CT (multidetector CT; 이하 MDCT) 소견을 정의하여 장기 손상척도에 통합한 것이다. 이전 장기 손상척도와 동일하게 세 가지 기준 중에 가장 높은 등급이 최종 등급이 된다. 또한 한 장기 내에 여러 개의 1등급 또는 2등급 소견이 있으면, 다발성 손상에 대해 3등급의 부여가 가능하다. 본 임상화보에서는 2018년 개정된 미국외상수술협회 장기 손상척도의 MDCT 소견을 소개하고자 한다.
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Affiliation(s)
- Hyo Hyeon Yu
- Department of Radiology, Uijeongbu St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Yoo Dong Won
- Department of Radiology, Uijeongbu St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Su Lim Lee
- Department of Radiology, Uijeongbu St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Young Mi Ku
- Department of Radiology, Uijeongbu St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Sun Wha Song
- Department of Radiology, Uijeongbu St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
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17
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Elshaer AR, Abdelsalam AA, Elgeyoushi FA, Allam AR. Managing post-traumatic gunshot thoraco-abdominal bleeding by intervention embolisation: A case report. J Taibah Univ Med Sci 2019; 14:193-198. [PMID: 31555071 PMCID: PMC6708075 DOI: 10.1016/j.jtumed.2019.02.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2019] [Revised: 02/11/2019] [Accepted: 02/13/2019] [Indexed: 11/14/2022] Open
Abstract
We report an interesting life-threating case of post-traumatic severe bleeding in the thoraco-abdominal region. The patient was initially treated by open surgery, which failed to control bleeding in the intrahepatic and sub-diaphragmatic regions of the liver with associated haematoma collection. As bleeding continued, on the 2nd post-operative day, the patient underwent super-selective embolisation of the bleeding vessels to cease serious bleeding. The pre-embolisation arterial feeders with active bleeding and post-embolisation images by computed tomography subtraction angiography showed complete cessation of haemorrhage. Torrential haemorrhage in the thoraco-abdominal regions can be successfully managed by trained interventional radiologists in highly specialised centres.
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Affiliation(s)
- Anas R Elshaer
- Department of Diagnostic and Interventional Radiology, King Fahad Hospital Madinah, KSA
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19
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Elkbuli A, Ehrhardt JD, McKenney M, Boneva D. Successful utilization of angioembolization and delayed laparoscopy in the management of grade 5 hepatic laceration: Case report and literature review. Int J Surg Case Rep 2019; 59:19-22. [PMID: 31100482 PMCID: PMC6522772 DOI: 10.1016/j.ijscr.2019.05.011] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2019] [Revised: 04/04/2019] [Accepted: 05/02/2019] [Indexed: 11/19/2022] Open
Abstract
INTRODUCTION The liver is the most commonly injured solid organ in blunt abdominal trauma. Although the incidence of hepatic lacerations continues to rise, non-operative management with angioembolization is currently the standard of care. While active arterial hemorrhage is commonly embolized in grade 3 or 4 injuries, patients with grade 5 injuries frequently require operative intervention. PRESENTATION OF CASE A 30-year-old man presented to our level I trauma center following a motor scooter accident. CT abdominal imaging revealed a grade 5 right lobar hepatic laceration. He underwent successful angioembolization without further hemorrhage. The patient later developed abdominal discomfort that worsened to peritonitis and he was taken for laparoscopic drainage of massive hemoperitoneum with bile peritonitis. Postoperatively, the patient's abdominal pain abated and he tolerated oral dietary advancement. DISCUSSION Surgical management of blunt hepatic trauma continues to evolve in tandem with minimally invasive interventional techniques. Patients with high-grade lacerations are at higher risk for developing biliary peritonitis, hemobilia, persistent hemoperitoneum, and venous hemorrhage after angioembolization. Accordingly, the primary role of surgery has shifted in select patients from laparotomy to delayed laparoscopy to address the aforementioned complications. CONCLUSION While laparotomy remains crucial for hemodynamically unstable patients, angioembolization is the primary treatment option for stable patients with hemorrhage from liver trauma. The combination of angioembolization and delayed laparoscopy may be considered in stable patients with even the highest liver injury grades.
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Affiliation(s)
- Adel Elkbuli
- Department of Surgery, Kendall Regional Medical Center, Miami, FL, United States.
| | - John D Ehrhardt
- Department of Surgery, Kendall Regional Medical Center, Miami, FL, United States
| | - Mark McKenney
- Department of Surgery, Kendall Regional Medical Center, Miami, FL, United States; University of South Florida, Tampa, FL, United States
| | - Dessy Boneva
- Department of Surgery, Kendall Regional Medical Center, Miami, FL, United States; University of South Florida, Tampa, FL, United States
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20
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Sakaray YR, Gupta V, Yadav TD, Kalra N, Singh V. Biliovascuar complications: a price to pay for non-operative management of major liver trauma. MINERVA CHIR 2019; 74:385-391. [PMID: 31062944 DOI: 10.23736/s0026-4733.19.07925-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND With non-operative management of major liver trauma, there has been an increased incidence of biliovascular complications which are reported variably. METHODS Fifty-six patients with age of 29.79±11.40 years and M:F 8.3:1, with grade III or more liver trauma were evaluated after stabilization for the development of liver related complications. Patients with active contrast extravasation at admission were managed with immediate angioembolization. Patients with prolonged hospital stay underwent repeat CT prior to discharge. Radiological, endoscopic and surgical interventions were carried out as appropriate. RESULTS Ninety-eight percent had blunt abdominal injury. Mean injury severity score was 25.68±10.389. Four (7%) required damage control laparotomy. CECT showed grade III injuries in 52%, grade IV in 30.4%, and grade V in 18%. 11% had laceration extending to porta. Seventeen patients had 21 liver-related complications: 4 biliary, 12 vascular and 1 combined biliary and vascular. Liver related complications were- 3.5% in grade III, 52% in grade IV and 70% in grade V. One patient with active arterio-portal fistula required urgent angioembolization while other arterial pseudoaneurysms were detected 7.23±5.14 days after trauma. Angioembolization was successful in 83% patients. On univariate and multivariate analysis, PRBC requirement and injury grade were the predictors of bilivascular complications. Laceration extending to porta was a predictor for biliary complications and not vascular. Repeat CT picked up 13 complications in 10 patients. CONCLUSIONS Biliovascular complications are managed by multidisciplinary approach. Lacerations extending to porta and grade IV/V injuries have a higher chance of developing biliovascular complications and should be observed closely.
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Affiliation(s)
- Yashwant R Sakaray
- Department of General Surgery, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Vikas Gupta
- Department of General Surgery, Postgraduate Institute of Medical Education and Research, Chandigarh, India -
| | - Thakur D Yadav
- Department of General Surgery, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Naveen Kalra
- Department of Radiodiagnosis, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Virendra Singh
- Department of Hepatology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
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21
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Nonoperative management of abdominal solid-organ injuries following blunt trauma in adults: Results from an International Consensus Conference. J Trauma Acute Care Surg 2019; 84:517-531. [PMID: 29261593 DOI: 10.1097/ta.0000000000001774] [Citation(s) in RCA: 52] [Impact Index Per Article: 10.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
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22
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Brillantino A, Iacobellis F, Festa P, Mottola A, Acampora C, Corvino F, Del Giudice S, Lanza M, Armellino M, Niola R, Romano L, Castriconi M, De Palma M, Noschese G. Non-Operative Management of Blunt Liver Trauma: Safety, Efficacy and Complications of a Standardized Treatment Protocol. Bull Emerg Trauma 2019; 7:49-54. [PMID: 30719466 PMCID: PMC6360015 DOI: 10.29252/beat-070107] [Citation(s) in RCA: 36] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023] Open
Abstract
Objective: To evaluate the safety and effectiveness of NOM (non-operative management) in the treatment of blunt liver trauma, following a standardized treatment protocol. Methods: All the hemodynamically stable patients with computed tomography (CT) diagnosis of blunt liver trauma underwent NOM. It included strict clinical and laboratory observation, 48-72h contrast enhanced ultrasonography (CEUS) or CT follow-up, a primary angioembolization in case of admission CT evidence of vascular injuries and a secondary angioembolization in presence of vascular injuries signs at follow-up CEUS. Results: 181 patients (85.4%) [55 (30.4%) women and 126 (69.6%) men, median age 39 (range 14–71)] were included. Of these, 63 patients (34.8%) had grade I, 48 patients (26.5%) grade II, 39 patients (21.5%) grade III, 21 patients (11.6%) grade IV and 10 patients (5.5%) grade V liver injuries. The overall success rate of NOM was 96.7% (175/181). There was not significant difference in the success rate between the patients with different liver injuries grade. Morbidity rate was 7.4% (13/175). Major complications (2 bilomas, 1 liver hematoma and 2 liver abscesses) were successfully treated by CEUS or CT guided drainage. Eighteen (18/181) patients (9.9%) underwent angioembolization with successful results. Conclusion: Non-operative management of blunt liver trauma represents a safe and effective treatment for both minor and severe injuries, achieving an high success rate and an acceptable morbidity rate. The angiographic study with embolization, although required only in selected cases of vascular injuries, represents a fundamental therapeutic option in a significant percentage of patients.
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Affiliation(s)
- Antonio Brillantino
- Department of Surgery, A. Cardarelli Hospital, Via A. Cardarelli 9 80131 Naples, Italy.,Antonio Brillantino and Francesca Iacobellis are equally contributors
| | - Francesca Iacobellis
- Department of Radiology, A. Cardarelli Hospital, Via A. Cardarelli 9 80131 Naples, Italy.,Antonio Brillantino and Francesca Iacobellis are equally contributors
| | - Patrizio Festa
- Department of Surgery, A. Cardarelli Hospital, Via A. Cardarelli 9 80131 Naples, Italy
| | - Arianna Mottola
- Department of Surgery, A. Cardarelli Hospital, Via A. Cardarelli 9 80131 Naples, Italy
| | - Ciro Acampora
- Department of Radiology, A. Cardarelli Hospital, Via A. Cardarelli 9 80131 Naples, Italy
| | - Fabio Corvino
- Interventional Radiology Department, A Cardarelli Hospital, Via A. Cardarelli 9 80131 Naples, Italy
| | - Santolo Del Giudice
- Department of Surgery, A. Cardarelli Hospital, Via A. Cardarelli 9 80131 Naples, Italy
| | - Michele Lanza
- Department of Surgery, A. Cardarelli Hospital, Via A. Cardarelli 9 80131 Naples, Italy
| | - Mariano Armellino
- Department of Surgery, A. Cardarelli Hospital, Via A. Cardarelli 9 80131 Naples, Italy
| | - Raffaella Niola
- Interventional Radiology Department, A Cardarelli Hospital, Via A. Cardarelli 9 80131 Naples, Italy
| | - Luigia Romano
- Department of Radiology, A. Cardarelli Hospital, Via A. Cardarelli 9 80131 Naples, Italy
| | - Maurizio Castriconi
- Department of Surgery, A. Cardarelli Hospital, Via A. Cardarelli 9 80131 Naples, Italy
| | - Maurizio De Palma
- Department of Surgery, A. Cardarelli Hospital, Via A. Cardarelli 9 80131 Naples, Italy
| | - Giuseppe Noschese
- Department of Surgery, A. Cardarelli Hospital, Via A. Cardarelli 9 80131 Naples, Italy
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Virdis F, Reccia I, Di Saverio S, Tugnoli G, Kwan SH, Kumar J, Atzeni J, Podda M. Clinical outcomes of primary arterial embolization in severe hepatic trauma: A systematic review. Diagn Interv Imaging 2018; 100:65-75. [PMID: 30555019 DOI: 10.1016/j.diii.2018.10.004] [Citation(s) in RCA: 32] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2018] [Revised: 10/06/2018] [Accepted: 10/09/2018] [Indexed: 11/25/2022]
Abstract
PURPOSE This purpose of this systematic review was to determine the safety and efficacy of arterial embolization as the primary treatment for grade III-V liver trauma, excluding the postoperative use of arterial embolization. MATERIAL AND METHODS A total of 24 studies published between January 2000 and June 2018 qualified for inclusion in this study. Four of them were prospective studies and 20 were retrospective. A total of 3855 patients (mean age, 33.5 years; range: 22-52.5 years) were treated non-operatively and 659 patients (659/3855; 17.09%) with hepatic hemorrhage underwent primary arterial embolization from 2000 to 2017. Indication for arterial embolization was a contrast blush visible on computed tomography in hemodynamically stable patient in all studies. RESULTS The arterial embolization success rate ranged from 80% to 97%. The most commonly reported complication was bile leak, with an incidence of 5.7%. Nineteen bilomas (2.8%) were reported in five studies with a range between 4% and 45%. Hepatic ischemia was reported in eight studies, with a mean incidence of 8.6%. CONCLUSION Primary arterial embolization has a high success rate in patients with hepatic trauma. Complications, including biloma and hepatic ischemia, have acceptable rates in the context of a minimally-invasive procedure that allows stabilization of life-threatening, complex liver injuries.
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Affiliation(s)
- F Virdis
- General Surgery Department, Hillingdon Hospital NHS Foundation Trust, Uxbridge, UB8 3NN, London, United Kingdom.
| | - I Reccia
- Haepato-Biliary-Pancreatic Unit, Hammersmith Hospital, Imperial College, Du Cane Road W120HS, London, United Kingdom
| | - S Di Saverio
- Department of Surgery, Addenbrooke's Hospital, Hills Rd, CB2 0QQ, Cambridge, United Kingdom
| | - G Tugnoli
- Trauma and Emergency Surgery Unit, Maggiore Hospital, Largo Nigrisoli, 2, 40133 Bologna BO, Italy
| | - S H Kwan
- Royal Perth Hospital, 97, Wellington St, Perth WA 6000, Australia
| | - J Kumar
- Department of Surgery & Cancer, Imperial College, Du Cane Road, W120HS London, United Kingdom
| | - J Atzeni
- General and Emergency Surgery Unit, Ns Signora di Bonaria Hospital, 09037 San Gavino, Italy
| | - M Podda
- General, Emergency and Robotic Surgery Unit, San Francesco Hospital, 08100 Nuoro NU, Italy
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Wong YC, Wang LJ, Wu CH, Chen HW, Fu CJ, Yuan KC, Lin BC, Hsu YP, Kang SC. Detection and characterization of traumatic bile leaks using Gd-EOB-DTPA enhanced magnetic resonance cholangiography. Sci Rep 2018; 8:14612. [PMID: 30279434 PMCID: PMC6168538 DOI: 10.1038/s41598-018-32976-0] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2018] [Accepted: 09/19/2018] [Indexed: 02/07/2023] Open
Abstract
Expanding bile leaks after blunt liver trauma require more aggressive treatment than contained bile leaks. In this retrospective study approved by institution review board, we analyzed if non-invasive contrast-enhanced magnetic resonance cholangiography (CEMRC) using hepatocyte-specific contrast agent (gadoxetic acid disodium) could detect and characterize traumatic bile leaks. Between March 2012 and December 2014, written informed consents from 22 included patients (17 men, 5 women) with a median age of 24.5 years (IQR 21.8, 36.0 years) were obtained. Biliary tree visualization and bile leak detection on CEMRC acquired at 10, 20, 30, 90 minutes time points were independently graded by three radiologists on a 5-point Likert scale. Intraclass Correlation (ICC) was computed as estimates of interrater reliability. Accuracy was measured by area under receiver operating characteristic curves (AUROC). Biliary tree visualization was the best on CEMRC at 90 minutes (score 4.30) with excellent inter-rater reliability (ICC = 0.930). Of 22 CEMRC, 15 had bile leak (8 expanding, 7 contained). The largest AUROC of bile leak detection by three radiologists were 0.824, 0.914, 0.929 respectively on CEMRC at 90 minutes with ICC of 0.816. In conclusion, bile leaks of blunt liver trauma can be accurately detected and characterized on CEMRC.
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Affiliation(s)
- Yon-Cheong Wong
- Emergency and Critical Care Radiology, Department of Medical Imaging and Intervention, Chang Gung Memorial Hospital, Chang Gung University, Taoyuan City, Taiwan. .,Center for Advanced Molecular Imaging and Translation, Taoyuan City, Taiwan.
| | - Li-Jen Wang
- Emergency and Critical Care Radiology, Department of Medical Imaging and Intervention, Chang Gung Memorial Hospital, Chang Gung University, Taoyuan City, Taiwan
| | - Cheng-Hsien Wu
- Emergency and Critical Care Radiology, Department of Medical Imaging and Intervention, Chang Gung Memorial Hospital, Chang Gung University, Taoyuan City, Taiwan
| | - Huan-Wu Chen
- Emergency and Critical Care Radiology, Department of Medical Imaging and Intervention, Chang Gung Memorial Hospital, Chang Gung University, Taoyuan City, Taiwan
| | - Chen-Ju Fu
- Emergency and Critical Care Radiology, Department of Medical Imaging and Intervention, Chang Gung Memorial Hospital, Chang Gung University, Taoyuan City, Taiwan
| | - Kuo-Ching Yuan
- Division of Trauma and Emergency Surgery, Department of Surgery, Chang Gung Memorial Hospital, Chang Gung University, Taoyuan City, Taiwan
| | - Being-Chuan Lin
- Division of Trauma and Emergency Surgery, Department of Surgery, Chang Gung Memorial Hospital, Chang Gung University, Taoyuan City, Taiwan
| | - Yu-Pao Hsu
- Division of Trauma and Emergency Surgery, Department of Surgery, Chang Gung Memorial Hospital, Chang Gung University, Taoyuan City, Taiwan
| | - Shih-Ching Kang
- Division of Trauma and Emergency Surgery, Department of Surgery, Chang Gung Memorial Hospital, Chang Gung University, Taoyuan City, Taiwan
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Latremouille R, Martinez-Quinones P, Lopez NS, White CQ. Gallbladder Necrosis after Right Hepatic Artery Embolization Due to Traumatic Hepatic Injury. Am Surg 2018. [DOI: 10.1177/000313481808400711] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Rachel Latremouille
- Department of General Surgery Medical College of Georgia at Augusta University Augusta, Georgia
| | | | - Nicole S. Lopez
- Department of General Surgery Medical College of Georgia at Augusta University Augusta, Georgia
| | - Cassandra Q. White
- Department of General Surgery Medical College of Georgia at Augusta University Augusta, Georgia
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Guo J, Tian G, Zhao Q, Jiang T. Fast hemostasis: a win-win strategy for ultrasound and microwave ablation. Onco Targets Ther 2018; 11:1395-1402. [PMID: 29559797 PMCID: PMC5856047 DOI: 10.2147/ott.s151219] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Introduction Hemorrhage is a serious complication following percutaneous biopsy requiring detecting and immediate treatment of active bleeding. This study aimed to explore the potential benefits of ultrasound (US)-guided microwave ablation (MWA) to treat acute hemorrhage in risky locations. Materials and methods We present seven patients (four males and three females) aged 19–69 years with solid-organ arterial hemorrhage treated by US-guided MWA and followed up with contrast-enhanced US (CEUS). Results All seven cases successfully underwent MWA for hemostasis, and their vital signs subsequently stabilized. During the follow-up from 13 to 36 days, the ablation area decreased slowly in five patients and was still stable in two cases. There were no complications observed in this study after MWA treatment. We also reviewed a total of 12 publications in the past 10 years. Conclusion This study suggested that US-guided MWA may be an effective and safe strategy for acute hemorrhage in the emergency setting. To confirm this method and benefit more patients, more prospective studies with larger samples and longer follow-ups are recommended.
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Affiliation(s)
- Jiabao Guo
- Department of Ultrasound Medicine, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Guo Tian
- Department of Ultrasound Medicine, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China.,Key Laboratory of Precision Diagnosis and Treatment for Hepatobiliary and Pancreatic Tumor of Zhejiang Province, Hangzhou, China
| | - Qiyu Zhao
- Department of Ultrasound Medicine, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Tian'an Jiang
- Department of Ultrasound Medicine, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China.,Key Laboratory of Precision Diagnosis and Treatment for Hepatobiliary and Pancreatic Tumor of Zhejiang Province, Hangzhou, China
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Tarchouli M, Elabsi M, Njoumi N, Essarghini M, Echarrab M, Chkoff MR. Liver trauma: What current management? Hepatobiliary Pancreat Dis Int 2018; 17:39-44. [PMID: 29428102 DOI: 10.1016/j.hbpd.2018.01.013] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2017] [Accepted: 11/02/2017] [Indexed: 02/05/2023]
Abstract
BACKGROUND The liver is the most commonly damaged organ in abdominal trauma. The management of liver trauma has experienced many changes over the last two decades. Currently there is a trend toward a non-operative treatment warranted by the successful pediatric experience and better results recorded in many trauma centers worldwide. This study aimed to evaluate outcomes of operative and non-operative management of liver trauma in our institution over the last five years. METHODS The patients with a diagnosis of blunt or penetrating liver injuries, admitted and managed in our hospital from January 2012 to December 2016 were retrospectively studied. The patients were divided into 2 groups, operated and non-operated groups, according to the initial management considered appropriate at the time of patient admission. Clinical features and outcomes were analyzed. RESULTS The study involved 83 patients, with a mean age of 33 years and a marked male predominance (85.5%). The most common type of lesions was blunt trauma and the main cause was road traffic accidents. Sixty-eight liver injuries (81.9%) were of low severity (grades I, II, III), while 15 (18.1%) were of high severity (grade IV or greater). Fifty-six patients (67.5%) had multiple injuries. Surgical treatment was performed in 26 (31.3%) patients. Non-operative management was undertaken in 57 cases (68.7%). The morbidity and mortality rates were clearly lower in non-operative patients compared to those in the operated group. CONCLUSIONS Careful non-operative management is an adequate therapeutic strategy for the patients suffering from liver trauma with stable hemodynamics. Patients with complex hepatic trauma and especially those with other organ injuries continue to have significantly higher mortality.
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Affiliation(s)
- Mohamed Tarchouli
- Department of Digestive Surgery, Mohammed V Military Hospital, Faculty of Medicine and Pharmacy, Sidi Mohamed Ben Abdellah University, Fes, Morocco.
| | - Mohamed Elabsi
- Department of Visceral Surgical Emergency, Ibn Sina Hospital, Faculty of Medicine and Pharmacy, Mohammed V University, Rabat, Morocco
| | - Noureddine Njoumi
- Department of Digestive Surgery, Mohammed V Military Hospital, Faculty of Medicine and Pharmacy, Mohammed V University, Rabat, Morocco
| | - Mohamed Essarghini
- Department of Digestive Surgery, Mohammed V Military Hospital, Faculty of Medicine and Pharmacy, Mohammed V University, Rabat, Morocco
| | - Mahjoub Echarrab
- Department of Visceral Surgical Emergency, Ibn Sina Hospital, Faculty of Medicine and Pharmacy, Mohammed V University, Rabat, Morocco
| | - Mohamed Rachid Chkoff
- Department of Visceral Surgical Emergency, Ibn Sina Hospital, Faculty of Medicine and Pharmacy, Mohammed V University, Rabat, Morocco
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Xu H, Jie L, Kejian S, Xiaojun H, Chengli L, Hongyi Z, Yalin K. Selective Angiographic Embolization of Blunt Hepatic Trauma Reduces Failure Rate of Nonoperative Therapy and Incidence of Post-Traumatic Complications. Med Sci Monit 2017; 23:5522-5533. [PMID: 29155699 PMCID: PMC5706383 DOI: 10.12659/msm.905115] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Background Conflict still remains as to the benefit of angioembolization (AE) for non-operative therapy (NOT) of blunt hepatic trauma (BHT). The aim of this study was to determine whether AE could result in lower failure rates in hemodynamically stable BHT patients with high failure risk factors for NOT, and to systematically evaluate the effectiveness of AE for NOT of BHT. Material/Methods Medical records of all BHT patients from January 1, 1998 to December 31, 2015 at a large trauma center were collected and analyzed. Failure of NOT (FNOT) occurred if hepatic surgery was performed after attempted NOT. Logistic regression analysis was used to identify factors associated with FNOT. Hepatobiliary complications related to hepatic trauma during follow-up were reviewed. Results No significant difference in FNOT for the no angiographic embolization (NO-AE) group versus angiographic embolization (AE) group was found in hepatic trauma of grades I, II, and V. However, decrease in FNOT was significant with AE performed for hepatic trauma of grades III to IV. Risk factors for FNOT included grade III to IV injuries and contrast blush on CT. Follow-up data of six months also showed that the incidence of hepatobiliary complications in the NO-AE group was higher than the AE group. Conclusions Hemodynamically stable BHT patients with grade III to IV injuries, contrast blush on initial CT, and/or decreasing hemoglobin levels can be candidates for selective AE during NOT course.
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Affiliation(s)
- Han Xu
- Department of Hepatobiliary Surgery, Zibo Central Hospital, Zibo, Shandong, China (mainland)
| | - Li Jie
- Department of Hepatobiliary Surgery, Zibo Central Hospital, Zibo, Shandong, China (mainland)
| | - Sun Kejian
- Department of Hepatobiliary Surgery, Zibo Central Hospital, Zibo, Shandong, China (mainland)
| | - He Xiaojun
- Department of Hepatobiliary Surgery, Chinese PLA Air Force General Hospital, Beijing, China (mainland)
| | - Liu Chengli
- Department of Hepatobiliary Surgery, Chinese PLA Air Force General Hospital, Beijing, China (mainland)
| | - Zhang Hongyi
- Department of Hepatobiliary Surgery, Chinese PLA Air Force General Hospital, Beijing, China (mainland)
| | - Kong Yalin
- Department of Hepatobiliary Surgery, Chinese PLA Air Force General Hospital, Beijing, China (mainland)
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Utility of Doppler ultrasonography for diagnosing and assessing treatment effects in liver compartment syndrome. Clin J Gastroenterol 2017; 10:265-269. [DOI: 10.1007/s12328-017-0741-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/13/2017] [Accepted: 04/14/2017] [Indexed: 10/19/2022]
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Abstract
In the last 30 years, the management of liver injury has evolved significantly. The advancement of imaging studies has played an important role in the conservative approach for management. A shift from operative to nonoperative management for most hemodynamically stable patients with hepatic injury has been prompted by speed and sensitivity of diagnostic imaging and by advances in critical care monitoring. In this review article, the up-to-date recommendation on the management approach of liver trauma will be discussed.
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Affiliation(s)
- Hanan M Alghamdi
- Department of Surgery, King Fahd Hospital of the University, Imam Abdulrahman bin Faisal University, Dammam, Saudi Arabia
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31
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Xuan F, Rong J, Liang M, Zhang X, Sun J, Zhao L, Li Y, Liu D, Li F, Wang X, Han Y. Biocompatibility and Effectiveness Evaluation of a New Hemostatic Embolization Agent: Thrombin Loaded Alginate Calcium Microsphere. BIOMED RESEARCH INTERNATIONAL 2017; 2017:1875258. [PMID: 28303245 PMCID: PMC5337789 DOI: 10.1155/2017/1875258] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/06/2016] [Accepted: 10/19/2016] [Indexed: 11/17/2022]
Abstract
Background. Until now, there has been no ideal embolization agent for hemorrhage in interventional treatment. In this study, the thrombin was encapsulated in alginate calcium microsphere using electrostatic droplet technique to produce new embolization agent: thrombin loaded alginate calcium microspheres (TACMs). Objectives. The present work was to evaluate the biocompatibility and hemostatic efficiency of TACMs. Methods. Cell cytotoxicity, hemolysis, and superselective embolization of dog liver arteries were performed to investigate the biocompatibility of TACMs. To clarify the embolic effect of TACMs mixed thrombus in vivo, hepatic artery injury animal model of 6 beagles was established and transcatheter artery embolization for bleeding was performed. Results. Coculture with VECs revealed the noncytotoxicity of TACMs, and the hemolysis experiment was negligible. Moreover, the histological study of TACMs in liver blood vessel showed signs of a slight inflammatory reaction. The results of transcatheter application of TACMs mixed thrombus for bleeding showed that the blood flow was shut down completely after the TACMs mixed thrombus was delivered and the postprocedural survival rate of animal models at 12 weeks was 100%. Conclusions. With their good biocompatibility and superior hemostatic efficiency, TACMs might be a promising new hemostatic agent with a wide range of potential applications.
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Affiliation(s)
- Fengqi Xuan
- Department of Cardiology, The General Hospital of Shenyang Military Region, Shenyang, Liaoning 110016, China
- Electrocardiogram Laboratory, Dezhou People's Hospital, Dezhou, Shandong 253000, China
| | - Jingjing Rong
- Department of Cardiology, The General Hospital of Shenyang Military Region, Shenyang, Liaoning 110016, China
| | - Ming Liang
- Department of Cardiology, The General Hospital of Shenyang Military Region, Shenyang, Liaoning 110016, China
| | - Xuwen Zhang
- Department of Ophthalmology, Dezhou People's Hospital, Dezhou, Shandong 253000, China
| | - Jingyang Sun
- Department of Cardiology, The General Hospital of Shenyang Military Region, Shenyang, Liaoning 110016, China
| | - Lijun Zhao
- Department of Cardiology, The General Hospital of Shenyang Military Region, Shenyang, Liaoning 110016, China
| | - Yang Li
- Department of Cardiology, The General Hospital of Shenyang Military Region, Shenyang, Liaoning 110016, China
| | - Dan Liu
- Department of Cardiology, The General Hospital of Shenyang Military Region, Shenyang, Liaoning 110016, China
| | - Fei Li
- Department of Cardiology, The General Hospital of Shenyang Military Region, Shenyang, Liaoning 110016, China
| | - Xiaozeng Wang
- Department of Cardiology, The General Hospital of Shenyang Military Region, Shenyang, Liaoning 110016, China
| | - Yaling Han
- Department of Cardiology, The General Hospital of Shenyang Military Region, Shenyang, Liaoning 110016, China
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Kobayashi T, Kubota M, Arai Y, Ohyama T, Yokota N, Miura K, Ishikawa H, Soma D, Takizawa K, Sakata J, Nagahashi M, Kameyama H, Wakai T. Staged laparotomies based on the damage control principle to treat hemodynamically unstable grade IV blunt hepatic injury in an eight-year-old girl. Surg Case Rep 2016; 2:134. [PMID: 27854071 PMCID: PMC5112224 DOI: 10.1186/s40792-016-0264-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2016] [Accepted: 11/10/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Severe blunt hepatic injury is a major cause of morbidity and mortality in pediatric patients. Damage control (DC) surgery has been reported to be useful in severely compromised children with hepatic injury. We applied such a technique in the treatment of a case of hemodynamically unstable grade IV blunt hepatic injury in an eight-year-old girl. This case is the first to use multimodal approaches including perihepatic packing, temporary closure of the abdominal wall with a plastic sheet, transarterial embolization (TAE), and planned delayed anatomical hepatic resection in a child. CASE PRESENTATION An eight-year-old girl was run over by a motor vehicle and transferred to the emergency department of the local hospital. Her diagnoses were severe blunt hepatic injury (grade IV) with left femoral trochanteric fracture. No other organ injuries were observed. Because her hemodynamic state was stable under aggressive fluid resuscitation, she was transferred to our hospital for surgical management. On arrival at our institution about 4 h after the injury, her hemodynamic condition became unstable. Abdominal compartment syndrome also became apparent. Because her condition had deteriorated and the lethal triad of low BT, coagulopathy, and acidosis was observed, a DC treatment strategy was selected. First, emergent laparotomy was performed for gauze-packing hemostasis to control intractable bleeding from the liver bed, and the abdomen was temporarily closed with a plastic sheet with continuous negative pressure aspiration. Transarterial embolization of the posterior branch of the right hepatic artery was then carried out immediately after the operation. The lacerated right lobe of the liver was safely resected in a stable hemodynamic condition 2 days after the initial operation. Bleeding from the liver bed ceased without further need of hemostasis. She was transferred to the local hospital without any surgical complications on day 42 after admission. She had returned to her normal life by 3 months after the injury. CONCLUSION The DC strategy was found to be effective even in a pediatric patient with hemodynamically unstable severe blunt hepatic injury. The presence of the deadly triad (hypothermia, coagulopathy, and acidosis) and abdominal compartment syndrome was an indication for DC surgery.
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Affiliation(s)
- Takashi Kobayashi
- Department of Pediatric Surgery, Niigata University Graduate School of Medical and Dental Sciences, 1-757, Asahimachi-dori, Chu-o-ku, Niigata, 951-8510, Japan.
| | - Masayuki Kubota
- Department of Pediatric Surgery, Niigata University Graduate School of Medical and Dental Sciences, 1-757, Asahimachi-dori, Chu-o-ku, Niigata, 951-8510, Japan
| | - Yuhki Arai
- Department of Pediatric Surgery, Niigata University Graduate School of Medical and Dental Sciences, 1-757, Asahimachi-dori, Chu-o-ku, Niigata, 951-8510, Japan
| | - Toshiyuki Ohyama
- Department of Pediatric Surgery, Niigata University Graduate School of Medical and Dental Sciences, 1-757, Asahimachi-dori, Chu-o-ku, Niigata, 951-8510, Japan
| | - Naoki Yokota
- Department of Pediatric Surgery, Niigata University Graduate School of Medical and Dental Sciences, 1-757, Asahimachi-dori, Chu-o-ku, Niigata, 951-8510, Japan
| | - Kohei Miura
- Division of Digestive and General Surgery, Niigata University Graduate School of Medical and Dental Sciences, Niigata, Japan
| | - Hirosuke Ishikawa
- Division of Digestive and General Surgery, Niigata University Graduate School of Medical and Dental Sciences, Niigata, Japan
| | - Daiki Soma
- Division of Digestive and General Surgery, Niigata University Graduate School of Medical and Dental Sciences, Niigata, Japan
| | - Kazuyasu Takizawa
- Division of Digestive and General Surgery, Niigata University Graduate School of Medical and Dental Sciences, Niigata, Japan
| | - Jun Sakata
- Division of Digestive and General Surgery, Niigata University Graduate School of Medical and Dental Sciences, Niigata, Japan
| | - Masayuki Nagahashi
- Division of Digestive and General Surgery, Niigata University Graduate School of Medical and Dental Sciences, Niigata, Japan
| | - Hitoshi Kameyama
- Division of Digestive and General Surgery, Niigata University Graduate School of Medical and Dental Sciences, Niigata, Japan
| | - Toshifumi Wakai
- Division of Digestive and General Surgery, Niigata University Graduate School of Medical and Dental Sciences, Niigata, Japan
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Coccolini F, Catena F, Moore EE, Ivatury R, Biffl W, Peitzman A, Coimbra R, Rizoli S, Kluger Y, Abu-Zidan FM, Ceresoli M, Montori G, Sartelli M, Weber D, Fraga G, Naidoo N, Moore FA, Zanini N, Ansaloni L. WSES classification and guidelines for liver trauma. World J Emerg Surg 2016; 11:50. [PMID: 27766112 PMCID: PMC5057434 DOI: 10.1186/s13017-016-0105-2] [Citation(s) in RCA: 73] [Impact Index Per Article: 9.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2016] [Accepted: 09/13/2016] [Indexed: 11/10/2022] Open
Abstract
The severity of liver injuries has been universally classified according to the American Association for the Surgery of Trauma (AAST) grading scale. In determining the optimal treatment strategy, however, the haemodynamic status and associated injuries should be considered. Thus the management of liver trauma is ultimately based on the anatomy of the injury and the physiology of the patient. This paper presents the World Society of Emergency Surgery (WSES) classification of liver trauma and the management Guidelines.
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Affiliation(s)
- Federico Coccolini
- General Emergency and Trauma Surgery Department, Papa Giovanni XXIII Hospital, Piazza OMS 1, 24127 Bergamo, Italy
| | - Fausto Catena
- Emergency and Trauma Surgery, Parma Maggiore Hospital, Parma, Italy
| | | | - Rao Ivatury
- Virginia Commonwealth University, Richmond, VA USA
| | - Walter Biffl
- Acute Care Surgery, The Queen's Medical Center, Honolulu, HI USA
| | - Andrew Peitzman
- Department of Surgery, Trauma and Surgical Services, University of Pittsburgh School of Medicine, Pittsburgh, USA
| | - Raul Coimbra
- Department of Surgery, UC San Diego Health System, San Diego, USA
| | - Sandro Rizoli
- Trauma & Acute Care Service, St Michael's Hospital, Toronto, ON Canada
| | - Yoram Kluger
- Division of General Surgery Rambam Health Care Campus, Haifa, Israel
| | - Fikri M Abu-Zidan
- Department of Surgery, College of Medicine and Health Sciences, UAE University, Al-Ain, United Arab Emirates
| | - Marco Ceresoli
- General Emergency and Trauma Surgery Department, Papa Giovanni XXIII Hospital, Piazza OMS 1, 24127 Bergamo, Italy
| | - Giulia Montori
- General Emergency and Trauma Surgery Department, Papa Giovanni XXIII Hospital, Piazza OMS 1, 24127 Bergamo, Italy
| | | | - Dieter Weber
- Department of General Surgery, Royal Perth Hospital, Perth, Australia
| | - Gustavo Fraga
- Faculdade de Ciências Médicas (FCM)-Unicamp, Campinas, SP Brazil
| | - Noel Naidoo
- Department of Surgery, University of KwaZulu-Natal, Durban, South Africa
| | | | - Nicola Zanini
- General Surgery Department, Infermi Hospital, Rimini, Italy
| | - Luca Ansaloni
- General Emergency and Trauma Surgery Department, Papa Giovanni XXIII Hospital, Piazza OMS 1, 24127 Bergamo, Italy
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Mine T, Murata S, Yasui D, Yokota H, Tajima H, Kumita SI. Glue Embolization of a Blunt Traumatic Hepatic Arteriovenous Fistula under Inflow and Outflow Control. J NIPPON MED SCH 2016; 83:27-30. [PMID: 26960586 DOI: 10.1272/jnms.83.27] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
We report on a rare case of blunt traumatic hepatic arteriovenous fistula arising from a pseudoaneurysm in a 35-year-old woman. Transarterial embolization was performed with n-butyl-2-cyanoacrylate, under inflow control with loose coil packing within the pseudoaneurysm and outflow control by balloon occlusion of the hepatic vein. A promising therapeutic outcome was achieved without any serious adverse events. Thus, the combination of these techniques to control inflow and outflow was successfully used to treat this rare hepatic vascular injury.
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Ierardi AM, Duka E, Lucchina N, Floridi C, De Martino A, Donat D, Fontana F, Carrafiello G. The role of interventional radiology in abdominopelvic trauma. Br J Radiol 2016; 89:20150866. [PMID: 26642310 DOI: 10.1259/bjr.20150866] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023] Open
Abstract
The management of trauma patients has evolved in recent decades owing to increasing availability of advanced imaging modalities such as CT. Nowadays, CT has replaced the diagnostic function of angiography. The latter is considered when a therapeutic option is hypothesized. Arterial embolization is a life-saving procedure in abdominopelvic haemorrhagic patients, reducing relevant mortality rates and ensuring haemodynamic stabilization of the patient. Percutaneous transarterial embolization has been shown to be effective for controlling ongoing bleeding for patients with high-grade abdominopelvic injuries, thereby reducing the failure rate of non-operative management, preserving maximal organ function. Surgery is not always the optimal solution for stabilization of a patient with polytrauma. Mini-invasivity and repeatability may be considered as relevant advantages. We review technical considerations, efficacy and complication rates of hepatic, splenic, renal and pelvic embolization to extrapolate current evidence about transarterial embolization in traumatic patients.
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Affiliation(s)
- Anna Maria Ierardi
- 1 Interventional Radiology Unit, Radiology Department, Uninsubria, Varese, Italy
| | - Ejona Duka
- 1 Interventional Radiology Unit, Radiology Department, Uninsubria, Varese, Italy
| | - Natalie Lucchina
- 1 Interventional Radiology Unit, Radiology Department, Uninsubria, Varese, Italy
| | - Chiara Floridi
- 1 Interventional Radiology Unit, Radiology Department, Uninsubria, Varese, Italy
| | | | - Daniela Donat
- 2 Clinical Center of Vojvodina, Department of Radiology, Novi Sad, Serbia
| | - Federico Fontana
- 1 Interventional Radiology Unit, Radiology Department, Uninsubria, Varese, Italy
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Kataoka Y, Minehara H, Kashimi F, Hanajima T, Yamaya T, Nishimaki H, Asari Y. Hybrid treatment combining emergency surgery and intraoperative interventional radiology for severe trauma. Injury 2016; 47:59-63. [PMID: 26508437 DOI: 10.1016/j.injury.2015.09.022] [Citation(s) in RCA: 35] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/13/2015] [Revised: 09/12/2015] [Accepted: 09/25/2015] [Indexed: 02/02/2023]
Abstract
OBJECT To evaluate the efficacy of hybrid treatment combining emergency surgery and intraoperative interventional radiology (IVR) for severe trauma. PATIENTS AND METHODS The records of 63 severely injured patients who underwent concurrent emergency surgery and IVR at our emergency centre from 1999 through 2013 were retrospectively reviewed. Mobile digital subtraction angiography device was used in the operating room when performing IVR. Patients undergoing hybrid treatment combining intraoperative IVR and emergency surgery (intraoperative IVR group) were compared with those undergoing IVR in the angiography suite before or after emergency surgery (control group). RESULTS Thirteen patients underwent hybrid treatment (intraoperative IVR group). Of these 13 patients, 7 underwent treatment for abdominal organ injuries, and 6 for multiregional injuries. Emergency operations were laparotomy (n=12), thoracotomy (n=1), craniotomy (n=1), and haemostasis of the lower extremities (n=1). Five patients underwent damage control surgery. IVR included transarterial embolisation (n=12), endovascular stent or stent-graft placement (n=2), and embolisation of a portal vein by laparotomy (n=2). The mean ISS was 40. The actual overall survival rate was 85%, and the probability of survival (Ps) was 62%. The control group included 45 patients. Five patients who met exclusion criteria were not included in the control group. Age, ISS, RTS, Ps, pH and base excess on arrival, and blood transfusion volume during operation and IVR did not differ significantly between the groups. Total time during operation and IVR was significantly shorter in the intraoperative IVR group than in the control group (229 [SD 72]min vs. 355 [SD 169]min; p=0.007). The mortality were 15 (95% CI 2-45) % in the intraoperative IVR group vs. 36 (95% CI 22-51) % in the control group. CONCLUSION Hybrid treatment combining emergency surgery and intraoperative IVR can be a novel treatment strategy for severe trauma, and it will improve patient outcomes due to reduction of the time for resuscitation.
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Affiliation(s)
- Yuichi Kataoka
- Department of Emergency and Critical Care Medicine, Kitasato University School of Medicine, Japan.
| | - Hiroaki Minehara
- Department of Emergency and Critical Care Medicine, Kitasato University School of Medicine, Japan.
| | - Fumie Kashimi
- Department of Emergency and Critical Care Medicine, Kitasato University School of Medicine, Japan.
| | - Tasuku Hanajima
- Department of Emergency and Critical Care Medicine, Kitasato University School of Medicine, Japan.
| | - Tatsuhiro Yamaya
- Department of Emergency and Critical Care Medicine, Kitasato University School of Medicine, Japan.
| | - Hiroshi Nishimaki
- Department of Cardiovascular Surgery, St. Marianna University School of Medicine, Japan.
| | - Yasushi Asari
- Department of Emergency and Critical Care Medicine, Kitasato University School of Medicine, Japan.
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Llau JV, Acosta FJ, Escolar G, Fernández-Mondéjar E, Guasch E, Marco P, Paniagua P, Páramo JA, Quintana M, Torrabadella P. [Multidisciplinary consensus document on the management of massive haemorrhage (HEMOMAS document)]. ACTA ACUST UNITED AC 2015; 63:e1-e22. [PMID: 26688462 DOI: 10.1016/j.redar.2015.11.002] [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: 02/05/2015] [Accepted: 05/17/2015] [Indexed: 12/23/2022]
Abstract
Massive haemorrhage is common and often associated with high morbidity and mortality. We perform a systematic review of the literature, with extraction of the recommendations from the existing evidences because of the need for its improvement and the management standardization. From the results we found, we wrote a multidisciplinary consensus document. We begin with the agreement in the definitions of massive haemorrhage and massive transfusion, and we do structured recommendations on their general management (clinical assessment of bleeding, hypothermia management, fluid therapy, hypotensive resuscitation and damage control surgery), blood volume monitoring, blood products transfusion (red blood cells, fresh frozen plasma, platelets and their best transfusion ratio), and administration of hemostatic components (prothrombin complex, fibrinogen, factor VIIa, antifibrinolytic agents).
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Affiliation(s)
- J V Llau
- Anestesia y Reanimación, Hospital Clínico Universitario de Valencia, Valencia, España
| | - F J Acosta
- Anestesia y Reanimación, Hospital Universitario Virgen de la Arrixaca, El Palmar, Murcia, España
| | - G Escolar
- Hemoterapia y Hematología, Hospital Clínic i Provincial de Barcelona, Barcelona, España
| | - E Fernández-Mondéjar
- Servicio de Cuidados Críticos y Urgencias, Hospital Universitario Virgen de las Nieves; Instituto de Investigación Biosanitaria ibs.Granada, Granada, España.
| | - E Guasch
- Anestesia y Reanimación, Hospital Universitario La Paz, Madrid, España
| | - P Marco
- Hemoterapia y Hematología, Hospital General de Alicante, Alicante, España
| | - P Paniagua
- Anestesia y Reanimación, Hospital de la Santa Creu i Sant Pau, Barcelona, España
| | - J A Páramo
- Hematología y Hemoterapia, Clínica Universidad de Navarra, Pamplona, España
| | - M Quintana
- Medicina Intensiva, Hospital Universitario La Paz, Madrid, España
| | - P Torrabadella
- Unidad de Cuidados Intensivos, Hospital Germans Trias i Pujol, Badalona, Barcelona, España
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Alarhayem AQ, Myers JG, Dent D, Lamus D, Lopera J, Liao L, Cestero R, Stewart R, Eastridge BJ. “Blush at first sight”: significance of computed tomographic and angiographic discrepancy in patients with blunt abdominal trauma. Am J Surg 2015; 210:1104-10; discussion 1110-1. [DOI: 10.1016/j.amjsurg.2015.08.009] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2015] [Revised: 08/20/2015] [Accepted: 08/25/2015] [Indexed: 12/12/2022]
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40
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Llau JV, Acosta FJ, Escolar G, Fernández-Mondéjar E, Guasch E, Marco P, Paniagua P, Páramo JA, Quintana M, Torrabadella P. Multidisciplinary consensus document on the management of massive haemorrhage (HEMOMAS document). Med Intensiva 2015; 39:483-504. [PMID: 26233588 DOI: 10.1016/j.medin.2015.05.002] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2015] [Revised: 05/14/2015] [Accepted: 05/17/2015] [Indexed: 12/30/2022]
Abstract
Massive haemorrhage is common and often associated with high morbidity and mortality. We perform a systematic review of the literature, with extraction of the recommendations from the existing evidences because of the need for its improvement and the management standardization. From the results we found, we wrote a multidisciplinary consensus document. We begin with the agreement in the definitions of massive haemorrhage and massive transfusion, and we do structured recommendations on their general management (clinical assessment of bleeding, hypothermia management, fluid therapy, hypotensive resuscitation and damage control surgery), blood volume monitoring, blood products transfusion (red blood cells, fresh frozen plasma, platelets and their best transfusion ratio), and administration of hemostatic components (prothrombin complex, fibrinogen, factor VIIa, antifibrinolytic agents).
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Affiliation(s)
- J V Llau
- Anestesia y Reanimación, Hospital Clínico Universitario de Valencia, Valencia, España
| | - F J Acosta
- Anestesia y Reanimación, Hospital Universitario Virgen de la Arrixaca, El Palmar, Murcia, España
| | - G Escolar
- Hemoterapia y Hematología, Hospital Clínic i Provincial de Barcelona, Barcelona, España
| | - E Fernández-Mondéjar
- Servicio de Cuidados Críticos y Urgencias, Hospital Universitario Virgen de las Nieves; Instituto de Investigación Biosanitaria ibs.Granada, Granada, España.
| | - E Guasch
- Anestesia y Reanimación, Hospital Universitario La Paz, Madrid, España
| | - P Marco
- Hemoterapia y Hematología, Hospital General de Alicante, Alicante, España
| | - P Paniagua
- Anestesia y Reanimación, Hospital de la Santa Creu i Sant Pau, Barcelona, España
| | - J A Páramo
- Hematología y Hemoterapia, Clínica Universidad de Navarra, Pamplona, España
| | - M Quintana
- Medicina Intensiva, Hospital Universitario La Paz, Madrid, España
| | - P Torrabadella
- Unidad de Cuidados Intensivos, Hospital Germans Trias i Pujol, Badalona, Barcelona, España
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Salcedo ES, Brown IE, Corwin MT, Galante JM. Angioembolization for solid organ injury: A brief review. Int J Surg 2015; 33:225-230. [PMID: 26537314 DOI: 10.1016/j.ijsu.2015.10.030] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2015] [Revised: 09/14/2015] [Accepted: 10/12/2015] [Indexed: 11/17/2022]
Abstract
INTRODUCTION Non-operative management is the standard of care for blunt solid organ injuries in stable patients. Angioembolization is an important technique that improves success rates of non-operative management. We aimed to provide a brief review of the indications, effectiveness and complications associated with angioembolization for solid organ injuries. METHODS We conducted a literature search of the PubMed database using the terms "trauma", "angioembolization", and "solid organ embolization" limited to studies published in the English language. Abstracts and full text were manually reviewed to identify suitable articles. RESULTS The current brief review is based on content from the more recently published articles related to angioembolization for solid organ injuries after trauma. DISCUSSION Angioembolization is appropriate for hemodynamically stable patients with contrast extravasation on CT scan or high-grade injury to a solid organ. Non-operative management success rates have improved with the adoption of angioembolization. The complications associated with angioembolization are acceptable in the context of avoiding a laparotomy, and are often related to the severity of the injury. CONCLUSION Angioembolization is a natural extension of the move towards non-operative management for solid organ injuries. Randomized controlled trials are required to fully characterize the indications and efficacy of its use.
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Affiliation(s)
- Edgardo S Salcedo
- University of California, Davis School of Medicine, Department of Surgery, Division of Trauma, Acute Care Surgery and Surgical Critical Care, 2315 Stockton Blvd, Room 4206, Sacramento, CA 95817, USA.
| | - Ian E Brown
- University of California, Davis School of Medicine, Department of Surgery, Division of Trauma, Acute Care Surgery and Surgical Critical Care, 2315 Stockton Blvd, Room 4206, Sacramento, CA 95817, USA.
| | - Michael T Corwin
- University of California, Davis School of Medicine, Department of Radiology, 4860 Y Street, ACC Suite 3100, Sacramento, CA 95817, USA.
| | - Joseph M Galante
- University of California, Davis School of Medicine, Department of Surgery, Division of Trauma, Acute Care Surgery and Surgical Critical Care, 2315 Stockton Blvd, Room 4206, Sacramento, CA 95817, USA.
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Coccolini F, Montori G, Catena F, Di Saverio S, Biffl W, Moore EE, Peitzman AB, Rizoli S, Tugnoli G, Sartelli M, Manfredi R, Ansaloni L. Liver trauma: WSES position paper. World J Emerg Surg 2015; 10:39. [PMID: 26309445 PMCID: PMC4548919 DOI: 10.1186/s13017-015-0030-9] [Citation(s) in RCA: 45] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2015] [Accepted: 07/24/2015] [Indexed: 01/13/2023] Open
Abstract
The liver is the most injured organ in abdominal trauma. Road traffic crashes and antisocial, violent behavior account for the majority of liver injuries. The present position paper represents the position of the World Society of Emergency Surgery (WSES) about the management of liver injuries.
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Affiliation(s)
- Federico Coccolini
- General, Emergency and Trauma Surgery, Papa Giovanni XXIII Hospital, P.zza OMS 1, 24128 Bergamo, Italy
| | - Giulia Montori
- General, Emergency and Trauma Surgery, Papa Giovanni XXIII Hospital, P.zza OMS 1, 24128 Bergamo, Italy
| | - Fausto Catena
- Emergency and Trauma Surgery, Maggiore Hospital, Parma, Italy
| | | | | | | | - Andrew B Peitzman
- Surgery Department, University of Pittsburgh, Pittsburgh, Pensylvania USA
| | - Sandro Rizoli
- Trauma & Acute Care Service, St Michael's Hospital, Toronto, ON Canada
| | - Gregorio Tugnoli
- General, Emergency and Trauma Surgery, Maggiore Hospital, Bologna, Italy
| | - Massimo Sartelli
- General and Emergency Surgery, Macerata Hospital, Macerata, Italy
| | - Roberto Manfredi
- General and Emergency Surgery, Macerata Hospital, Macerata, Italy
| | - Luca Ansaloni
- General, Emergency and Trauma Surgery, Papa Giovanni XXIII Hospital, P.zza OMS 1, 24128 Bergamo, Italy
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Zhou L, Kuang M, Xu Z, Xie X, Lu M. Contrast-enhanced sonographically guided thermal ablation for treatment of solid-organ hemorrhage: preliminary clinical results. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2015; 34:907-915. [PMID: 25911724 DOI: 10.7863/ultra.34.5.907] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
The purpose of this series was to preliminarily evaluate the use of contrast-enhanced sonographically guided percutaneous thermal ablation in the evaluation and treatment of solid-organ bleeding by retrospectively analyzing 6 cases observed in clinical practice. Six patients who underwent contrast-enhanced sonographically guided thermal ablation for treatment of solid-organ bleeding (5 in liver and 1 in spleen) from December 2005 to August 2012 were included in this series. Clinical information, contrast-enhanced sonograms before and after ablation, and the ablation method were retrospectively collected and analyzed. In 5 of the 6 patients, the location of the bleeding lesion was clearly seen. Hemostasis was successfully achieved in 4 of these 5 patients: 1 by radiofrequency ablation and 3 by microwave ablation. Ablation failed to achieve hemostasis in 1 patient who had postbiopsy splenic arterial bleeding because the bleeding vessel was a thick branch of the splenic artery. In the sixth remaining patient, who had bleeding after liver biopsy, hemostasis failed because contrast-enhanced sonography did not precisely locate the bleeding lesion; hence, the ablation zone did not cover the whole lesion. Contrast-enhanced sonographically guided ablation can be an alternative choice for treating solid-organ bleeding because of its effectiveness and minimal invasiveness. However, it should be carefully investigated for those in whom the bleeding lesion cannot be located by contrast-enhanced sonography and in those who have bleeding in a large vessel.
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Affiliation(s)
- Luyao Zhou
- Department of Medical Ultrasonics, Institute for Diagnostic and Interventional Ultrasound (L.Z., Z.X., X.X.), and Department of Hepatobiliary Surgery (M.K., M.L.), First Affiliated Hospital, Sun Yat-Sen University, Guangzhou, China
| | - Ming Kuang
- Department of Medical Ultrasonics, Institute for Diagnostic and Interventional Ultrasound (L.Z., Z.X., X.X.), and Department of Hepatobiliary Surgery (M.K., M.L.), First Affiliated Hospital, Sun Yat-Sen University, Guangzhou, China
| | - Zuofeng Xu
- Department of Medical Ultrasonics, Institute for Diagnostic and Interventional Ultrasound (L.Z., Z.X., X.X.), and Department of Hepatobiliary Surgery (M.K., M.L.), First Affiliated Hospital, Sun Yat-Sen University, Guangzhou, China
| | - Xiaoyan Xie
- Department of Medical Ultrasonics, Institute for Diagnostic and Interventional Ultrasound (L.Z., Z.X., X.X.), and Department of Hepatobiliary Surgery (M.K., M.L.), First Affiliated Hospital, Sun Yat-Sen University, Guangzhou, China
| | - Mingde Lu
- Department of Medical Ultrasonics, Institute for Diagnostic and Interventional Ultrasound (L.Z., Z.X., X.X.), and Department of Hepatobiliary Surgery (M.K., M.L.), First Affiliated Hospital, Sun Yat-Sen University, Guangzhou, China
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Ward J, Alarcon L, Peitzman AB. Management of blunt liver injury: what is new? Eur J Trauma Emerg Surg 2015; 41:229-37. [PMID: 26038039 DOI: 10.1007/s00068-015-0521-0] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2014] [Accepted: 03/11/2015] [Indexed: 12/26/2022]
Abstract
Nonoperative management has become the surgical treatment of choice in the hemodynamically stable patient with blunt hepatic trauma. The increased use and success of nonoperative management have been facilitated by the development of increasingly higher resolution computed tomography imaging, improved management of physiology and resuscitation (damage control), and routine availability of interventional procedures such as angiography and embolization, image-guided percutaneous drainage, and endoscopy. On the other hand, recognition of the patient who should proceed to immediate laparotomy is of utmost importance. A systematic and logical approach to the control of hemorrhage is required in the operating room. Thorough knowledge of the anatomy and surgical techniques, such as perihepatic packing, effective Pringle maneuver, hepatic mobilization, infrahepatic and suprahepatic control of the IVC, and stapled hepatectomy, is essential.
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Affiliation(s)
- J Ward
- Department of Surgery, University of Pittsburgh, F-1281, UPMC-Presbyterian, 200 Lothrop Street, Pittsburgh, PA, 15213, USA
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Liver Trauma in the Kitchen: Preparing Whipped Cream with a Siphon Is Not without Risk. Case Rep Crit Care 2015; 2015:213039. [PMID: 26137325 PMCID: PMC4475528 DOI: 10.1155/2015/213039] [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: 01/26/2015] [Revised: 05/13/2015] [Accepted: 05/21/2015] [Indexed: 11/28/2022] Open
Abstract
We report the case of a 36-year-old woman suffering from liver injury caused by the malfunction of a whipped cream siphon. When this patient handled the whipped cream siphon, the screwed metallic upper part of the siphon was suddenly dissociated from its base and came violently striking her right hypochondrium. At first, the severity of injury was underestimated. Subsequently, due to the persistence of pain experienced by the patient, an abdominal CT scan was performed. It highlighted a severe liver injury with rupture of a branch of the hepatic artery. The evolution was favorable after completion of an embolization and a secondary capsular rupture.
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Brenner M, Hoehn M, Rasmussen TE. Endovascular therapy in trauma. Eur J Trauma Emerg Surg 2014; 40:671-8. [PMID: 26814781 DOI: 10.1007/s00068-014-0474-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2014] [Accepted: 11/03/2014] [Indexed: 11/26/2022]
Abstract
The practice of medicine has experienced a revolution in the use of catheter-based or endovascular techniques to manage age-related vascular disease over the past 15 years. In many scenarios the less invasive, endovascular method is associated with reduced morbidity and mortality than the traditional open surgical approach. Although somewhat delayed, the use of endovascular approaches in the management of certain trauma scenarios has also increased dramatically. With improvements in catheter-based and imaging technologies and a broader acceptance of the value of the endovascular approach, this trend is likely to continue to the benefit of patients. The use of endovascular techniques in trauma can be considered in three broad categories: (1) large-vessel repair (e.g. covered stent repair), (2) mid- to small-vessel hemostasis (e.g. coils, plugs, and hemostatic agents), and (3) large-vessel balloon occlusion for resuscitation (e.g. resuscitative endovascular balloon occlusion of the aorta). While not exclusive, these categories provide a framework from which to consider establishing a trauma-specific endovascular inventory and performance of these techniques in the setting of severe injury. The aim of this review is to use this framework to provide a current appraisal of endovascular techniques to manage various forms: vascular injury, bleeding, and shock; including injury patterns in which an endovascular approach is established and scenarios in which it is nascent and evolving.
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Affiliation(s)
- M Brenner
- University of Maryland Shock Trauma Center, Baltimore, MD, USA
| | - M Hoehn
- University of Maryland Shock Trauma Center, Baltimore, MD, USA
| | - T E Rasmussen
- University of Maryland Shock Trauma Center, Baltimore, MD, USA.
- Uniformed Services University of the Health Sciences, Bethesda, MD, USA.
- US Combat Casualty Care Research Program, 722 Doughten Street, Room 3, Fort Detrick, MD, 21702-5012, USA.
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Balakrishnan A, Abbadi R, Oakland K, Jamdar S, Harper SJ, Jamieson NV, Huguet EL, Jah A, Praseedom RK. Outcomes following liver trauma in equestrian accidents. J Trauma Manag Outcomes 2014; 8:13. [PMID: 25177363 PMCID: PMC4148498 DOI: 10.1186/1752-2897-8-13] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2014] [Accepted: 08/01/2014] [Indexed: 12/26/2022]
Abstract
Background Equestrian sports are common outdoor activities that may carry a risk of liver injury. Due to the relative infrequency of equestrian accidents the injury patterns and outcomes associated with liver trauma in these patients have not been well characterized. Methods We examined our experience of the management of equestrian liver trauma in our regional hepatopancreaticobiliary unit at a tertiary referral center. The medical records of patients who sustained liver trauma secondary to equestrian activities were analysed for parameters such as demographic data, liver function tests, patterns of injury, radiological findings, the need for intervention and outcomes. Results 20 patients sustained liver trauma after falling from or being kicked by a horse. The majority of patients were haemodynamically stable on admission. Alanine transaminase (ALT) levels were elevated in all patients and right-sided rib fractures were a frequently associated finding. CT demonstrated laceration of the liver in 12 patients, contusion in 3 and subcapsular haematoma in 2. The right lobe of the liver was most commonly affected. Only two patients required laparotomy and liver resection; the remaining 18 were successfully managed conservatively. Conclusions The risk of liver injury following a horse kick or falling off a horse should not be overlooked. Early CT imaging is advised in these patients, particularly in the presence of high ALT levels and concomitant chest injuries such as rib fractures. Despite significant liver trauma, conservative management in the form of close observation, ideally in a high-dependency setting, is often sufficient. Laparotomy is only rarely warranted and associated with a significantly higher risk of post-operative bile leaks.
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Affiliation(s)
- Anita Balakrishnan
- Department of Hepatopancreaticobiliary Surgery, Addenbrooke's Hospital and Cambridge University, Hills Road, Cambridge CB2 0QQ, UK
| | - Reyad Abbadi
- Department of Hepatopancreaticobiliary Surgery, Bristol Royal Infirmary, Marlborough Street, Bristol BS2 8HW, UK
| | - Kathryn Oakland
- Department of Hepatopancreaticobiliary Surgery, Addenbrooke's Hospital and Cambridge University, Hills Road, Cambridge CB2 0QQ, UK
| | - Saurabh Jamdar
- Hepatobiliary Surgery Unit, Manchester Royal Infirmary, Oxford Road, Manchester M13 9WL, UK
| | - Simon Jf Harper
- Department of Hepatopancreaticobiliary Surgery, Addenbrooke's Hospital and Cambridge University, Hills Road, Cambridge CB2 0QQ, UK
| | - Neville V Jamieson
- Department of Hepatopancreaticobiliary Surgery, Addenbrooke's Hospital and Cambridge University, Hills Road, Cambridge CB2 0QQ, UK
| | - Emmanual L Huguet
- Department of Hepatopancreaticobiliary Surgery, Addenbrooke's Hospital and Cambridge University, Hills Road, Cambridge CB2 0QQ, UK
| | - Asif Jah
- Department of Hepatopancreaticobiliary Surgery, Addenbrooke's Hospital and Cambridge University, Hills Road, Cambridge CB2 0QQ, UK
| | - Raaj K Praseedom
- Department of Hepatopancreaticobiliary Surgery, Addenbrooke's Hospital and Cambridge University, Hills Road, Cambridge CB2 0QQ, UK
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Yuan KC, Wong YC, Fu CY, Chang CJ, Kang SC, Hsu YP. Screening and management of major bile leak after blunt liver trauma: a retrospective single center study. Scand J Trauma Resusc Emerg Med 2014; 22:26. [PMID: 24735590 PMCID: PMC4012546 DOI: 10.1186/1757-7241-22-26] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2014] [Accepted: 03/28/2014] [Indexed: 12/27/2022] Open
Abstract
BACKGROUND Major bile leak after blunt liver trauma is rare but challenging. It usually requires endoscopic retrograde cholangiography (ERC) for management. However, there is still lack of specific indications. The aim of this study is to elucidate risk factors for major bile leak and indications for early ERC after blunt liver trauma. METHODS The trauma registry of a level I trauma center in Taiwan was queried, and all blunt liver trauma patients from June, 2008 to June, 2011 were selected for retrospective review. Data collected included demographic data, laboratory data, Injury Severity Score (ISS), liver injury grade and location, management of liver trauma, length of ICU, hospital stay and treatment result. ERC was used to confirm major bile leak. RESULTS 288 blunt liver trauma patients were selected from 2,475 torso trauma patients. There were 214 (74.5%) male and 74 (25.7%) female patients. The mean ISS was 24.2. Most patients received conservative treatment. Transcatheter artery embolization (TAE) and operation were 15.6% and 10.8% respectively. Major bile leak occurred in 14 (4.9%) patients. Risk factors for bile leak include high-grade liver injury, centrally-located liver trauma and use of TAE. A bilirubin level greater than 43.6 μmol/L provides a sensitivity of 100% and specificity of 85.1% for predicting major bile leak. CONCLUSIONS High injury grade; centrally-located liver trauma; and use of TAE are risk factors for major bile leak after blunt liver trauma. ERC should be arranged early if the patient has risk factors and their plasma bilirubin level is greater than 43.6 μmol/L during admission.
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Affiliation(s)
| | | | | | | | | | - Yu-Pao Hsu
- Department of Trauma and Emergency Surgery, Chang Gung Memorial Hospital, Linkou, Chang Gung University, No,5, Fusing St, Gueishan Township Taoyuan County 333, Taiwan.
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Kong YL, Zhang HY, He XJ, Zhao G, Liu CL, Xiao M, Zhen YY. Angiographic embolization in the treatment of intrahepatic arterial bleeding in patients with blunt abdominal trauma. Hepatobiliary Pancreat Dis Int 2014; 13:173-8. [PMID: 24686544 DOI: 10.1016/s1499-3872(14)60027-8] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
BACKGROUND Angiographic embolization (AE) as an adjunct non-operative treatment of intrahepatic arterial bleeding has been widely used. The present study aimed to evaluate the efficacy of selective AE in patients with hepatic trauma. METHODS Seventy patients with intrahepatic arterial bleeding after blunt abdominal trauma who had undergone selective AE in 10 years at this institution were retrospectively reviewed. The criteria for selective AE included active extravasation on contrast-enhanced CT, an episode of hypotension or a decrease in hemoglobin level during the non-operative treatment. The data of the patients included demographics, grade of liver injuries, mechanism of blunt abdominal trauma, associated intra-abdominal injuries, indications for AE, angiographic findings, type of AE, and AE-related hepatobiliary complications. RESULTS In the 70 patients, 32 (45.71%) had high-grade liver injuries. Extravazation during the early arterial phase mainly involved the right hepatic segments. Thirteen (18.57%) patients underwent embolization of intrahepatic branches and the extrahepatic trunk and these patients all developed AE-related hepatobiliary complications. In 19 patients with AE-related complications, 14 received minimally invasive treatment and recovered without severe sequelae. CONCLUSIONS AE is an adjunct treatment for liver injuries. Selective and/or super-selective AE should be advocated to decrease the incidence and severity of AE-related hepatobiliary complications.
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Affiliation(s)
- Ya-Lin Kong
- Hepatobiliary Surgery Department, Chinese PLA Air Force General Hospital, Beijing 100142, China.
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Tokue H, Tokue A, Tsushima Y. Successful interventional management of abdominal compartment syndrome caused by blunt liver injury with hemorrhagic diathesis. World J Emerg Surg 2014; 9:20. [PMID: 24656215 PMCID: PMC3994338 DOI: 10.1186/1749-7922-9-20] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2013] [Accepted: 03/18/2014] [Indexed: 11/10/2022] Open
Abstract
We report that a case of primary abdominal compartment syndrome (ACS), caused by blunt liver injury under the oral anticoagulation therapy, was successfully treated. Transcatheter arterial embolization (TAE) was initially selected, and the bleeding point of hepatic artery was embolized with N-Butyl Cyanoacylate (NBCA). Secondary, percutaneous catheter drainage (PCD) was performed for massive hemoperitoneum. There are some reports of ACS treated with TAE. However, combination treatment of TAE with NBCA and PCD for ACS has not been reported. Even low invasive interventional procedures may improve primary ACS if the patient has hemorrhagic diathesis or coagulopathy discouraging surgeon from laparotomy.
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Affiliation(s)
- Hiroyuki Tokue
- Department of Diagnostic and Interventional Radiology, Gunma University Hospital, 3-39-22 Showa-machi, Maebashi, Gunma 371-8511, Japan.
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