scholarly journals Severe Hepatic Trauma: Nonoperative Management, Definitive Repair, or Damage Control Surgery?

2011 ◽  
Vol 35 (12) ◽  
pp. 2643-2649 ◽  
Author(s):  
Ari K. Leppäniemi ◽  
Panu J. Mentula ◽  
Mari H. Streng ◽  
Mika P. Koivikko ◽  
Lauri E. Handolin
Keyword(s):  
Nonoperative Management ◽  
Damage Control ◽  
Damage Control Surgery ◽  
Hepatic Trauma ◽  
Definitive Repair

Operative Exposure of Abdominal Injuries and Closure of the Abdomen

2019 ◽  
Author(s):  
Matthew D Nealeigh ◽  
Mark W Bowyer
Keyword(s):  
Open Abdomen ◽  
Nonoperative Management ◽  
Damage Control ◽  
Damage Control Surgery ◽  
Damage Control Resuscitation ◽  
Abdominal Injuries ◽  
Penetrating Injuries ◽  
Optimal Outcomes ◽  
Medial Rotation ◽  
Selective Nonoperative Management

Operative exposure and management of significant blunt or penetrating injuries to the abdomen is a critical skill required of all surgeons caring for victims of trauma. Application of damage control resuscitation and damage control surgical principles improves survival. Advances in diagnostics, increasing experience with selective nonoperative management, and use of endovascular and angiographic techniques have all significantly decreased the frequency of laparotomies performed for trauma. This decreasing clinical experience mandates that surgeons dealing with victims of trauma remain facile with the operative approaches and techniques detailed in this chapter to achieve optimal outcomes. Detailed management of specific injuries is covered in other chapters of this text. This review contains 7 figures, 2 tables, and 41 references.  Key Words: abdominal trauma, damage control resuscitation, damage control surgery, endovascular control of hemorrhage, open abdomen, REBOA, supraceliac control of aorta, trauma systems, visceral medial rotation

Changes in Approach to Solid Organ Injury: What the Radiologist Needs to Know

2020 ◽  
Vol 71 (3) ◽  
pp. 352-361
Author(s):  
Siobhán B. O’Neill ◽  
Saira Hamid ◽  
Savvas Nicolaou ◽  
Sadia R. Qamar
Keyword(s):  
American Association ◽  
Nonoperative Management ◽  
Damage Control ◽  
Management Strategies ◽  
Damage Control Surgery ◽  
Organ Injury ◽  
Solid Organ ◽  
Imaging Findings ◽  
Solid Organ Injury ◽  
Imaging Protocols

This review aims to examine the challenges facing radiologists interpreting trauma computed tomography (CT) images in this era of a changing approach to management of solid organ trauma. After reviewing the pearls and pitfalls of CT imaging protocols for detection of traumatic solid organ injuries, we describe the key changes in the 2018 American Association for the Surgery of Trauma Organ Injury Scales for liver, spleen, and kidney and their implications for management strategies. We then focus on the important imaging findings in observed in patients who undergo nonoperative management and patients who are imaged post damage control surgery.

scholarly journals Management of complications of first instance of hepatic trauma in a liver surgery unit: Portal vein ligation as a conservative therapeutic strategy

Open Medicine ◽  
2019 ◽  
Vol 14 (1) ◽  
pp. 376-383 ◽  
Author(s):  
Aldo Rocca ◽  
Enrico Andolfi ◽  
Anna Ginevra Immacolata Zamboli ◽  
Giuseppe Surfaro ◽  
Domenico Tafuri ◽  
...  
Keyword(s):  
Portal Vein ◽  
Damage Control ◽  
Pathological Finding ◽  
Damage Control Surgery ◽  
Liver Trauma ◽  
The Other ◽  
Portal Vein Ligation ◽  
Bleeding Site ◽  
Hepatic Trauma ◽  
Management Of Complications

AbstractBackgroundAccording to the National Trauma Data Bank, the liver, after the spleen, is the first most injured organ in closed abdominal trauma.MethodsFrom June 2010 to December 2015 we observed in our department of Hepato-biliary Surgery and Liver Transplant Unit of the A.O.R.N. A. Cardarelli of Naples 40 patients affected by hepatic trauma. In our retrospective study, we review our experience and propose portal vein ligation (PVL) as a first – line strategy for damage control surgery (DCS) in liver trauma.Results26/40 patients (65%) which received gauze-packing represented our study group. In 10 cases out of 26 patients (38,4%) the abdominal packing was enough to control the damage. In 7 cases (18,4%) we performed a liver resection. In 7 cases, after de-packing, we adopted PVL to achieve DCS. Trans Arterial Embolization was chosen in 6 patients. 2 of them were discharged 14 days later without performing any other procedure.In 3 cases we had to perform a right epatectomy in second instance. Two hepatectomies were due to hemoperitoneum, and the other for coleperitoneum. Two patients were treated in first instance by only doing hemostasis on the bleeding site. We observed 6 patients in first instance. Five of them underwent surgery with hepatic resection and surgical hemostasis of the bleeding site. The other one underwent to conservative management. In summary we performed 15 hepatic resections, 8 of them were right hepatectomies, 1 left hepatectomy, 2 trisegmentectomies V-VI-VII. So in second instance we operated on 10 patients out of 34 (30%).ConclusionsThe improved knowledge of clinical physio-pathology and the improvement of diagnostic and instrumental techniques had a great impact on the prognosis of liver trauma. We think that a rigid diagnostic protocol should be applied as this allows timely pathological finding, and consists of three successive but perfectly integrated steps: 1) patient reception, in close collaboration with the resuscitator; 2) accurate but quick diagnostic framing 3) therapeutic decisional making. Selective portal vein ligation is a well-tolerated and safe manoeuvre, which could be effective, even if not definitive, in treating these subjects. That is why we believe that it can be a choice to keep in mind especially in post-depacking bleeding.

scholarly journals Damage control in the intensive care unit: what should the intensive care physician know and do?

2021 ◽  
Vol 52 (2) ◽  
pp. e4174810
Author(s):  
Monica Vargas ◽  
Alberto Garcia ◽  
Yaset Caicedo ◽  
Michael Parra ◽  
Carlos Alberto Ordoñez
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Damage Control ◽  
Damage Control Surgery ◽  
Severe Trauma ◽  
Massive Hemorrhage ◽  
Care Physician ◽  
Trauma Patients ◽  
Physiological Alterations ◽  
Definitive Repair

When trauma patients are admitted into the intensive care unit after undergoing damage control surgery, they generally present some degree of bleeding, hypoperfusion, and injuries that require definitive repair. Trauma patients admitted into the intensive care unit after undergoing damage control surgery can present injuries that require a definite repair, which can cause bleeding and hypoperfusion. The intensive care team must evaluate the severity and systemic repercussions in the patient. This will allow them to establish the need for resuscitation, anticipate potential complications, and adjust the treatment to minimize trauma-associated morbidity and mortality. This article aims to describe the alterations present in patients with severe trauma who undergo damage control surgery and considerations in their therapeutic approach. The intensivist must detect the different physiological alterations presented in trauma patients undergoing damage control surgery, mainly caused by massive hemorrhage. Monitor and support strategies are defined by the evaluation of bleeding and shock severity and resuscitation phase in ICU admission. The correction of hypothermia, acidosis, and coagulopathy is fundamental in the management of severe trauma patients.

scholarly journals Epidemiological evaluation of hepatic trauma victims undergoing surgery

2016 ◽  
Vol 43 (1) ◽  
pp. 22-27 ◽  
Author(s):  
Mitre Kalil ◽  
Isaac Massaud Amim Amaral
Keyword(s):  
Blunt Trauma ◽  
Damage Control ◽  
Penetrating Trauma ◽  
Damage Control Surgery ◽  
Liver Trauma ◽  
Metropolitan Region ◽  
Trauma Patients ◽  
Hepatic Trauma ◽  
Female Ratio ◽  
Packed Red Blood Cells

Objective : to evaluate the epidemiological variables and diagnostic and therapeutic modalities related to hepatic trauma patients undergoing laparotomy in a public referral hospital in the metropolitan region of Vitória-ES. Methods : we conducted a retrospective study, reviewing charts of trauma patients with liver injuries, whether isolated or in association with other organs, who underwent exploratory laparotomy, from January 2011 to December 2013. Results : We studied 392 patients, 107 of these with liver injury. The male: female ratio was 6.6 : 1 and the mean age was 30.12 years. Penetrating liver trauma occurred in 78.5% of patients, mostly with firearms. Associated injuries occurred in 86% of cases and intra-abdominal injuries were more common in penetrating trauma (p <0.01). The most commonly used operative technique was hepatorrhaphy and damage control surgery was applied in 6.5% of patients. The average amounts of blood products used were 6.07 units of packed red blood cells and 3.01 units of fresh frozen plasma. The incidence of postoperative complications was 29.9%, the most frequent being infectious, including pneumonia, peritonitis and intra-abdominal abscess. The survival rate of patients suffering from blunt trauma was 60%, and penetrating trauma, 87.5% (p <0.05). Conclusion : despite technological advances in diagnosis and treatment, mortality rates in liver trauma remain high, especially in patients suffering from blunt trauma in relation to penetrating one.

scholarly journals Damage Control Orthopedic Surgery.

2018 ◽  
Vol 2 (1) ◽  
Author(s):  
Fatmir Brahimi ◽  
Edvin Selmani ◽  
Leard Duraj
Keyword(s):  
Intensive Care Unit ◽  
Orthopedic Surgery ◽  
Damage Control ◽  
Damage Control Surgery ◽  
Abdominal Wound ◽  
Successful Resuscitation ◽  
Abdominal Closure ◽  
Lethal Triad ◽  
Rapid Control ◽  
Definitive Repair

The concept of damage control surgery was first described for the purpose of treating medically un-stable patients with abdominal trauma. The purpose of such surgery is rapid control of hemorrhage and contamination, not definitive repair of injuries. The goal is to improve survival of patients with the potentially lethal triad of hypothermia, acidosis and coagulopathy. Definitive repair of injuries and abdominal closure are not performed at the time of initial laparotomy. Rather, the abdominal wound is left open, a dressing is placed, and the patient is transported to the intensive care unit for continued re-suscitation. This includes optimization of hemodynamic condition, respiratory support, warming, and correction of coagulopathy. Following successful resuscitation, when the patient is medically stable, a return to the operating room is scheduled for repair of injuries and abdominal closure.

scholarly journals Damage control of peripheral vascular trauma - Don’t be afraid of axillary or popliteal fosses

2021 ◽  
Vol 52 (2) ◽  
pp. e4114735
Author(s):  
Mario Alain Herrera ◽  
Mauricio Millan ◽  
Ana Milena Del Valle ◽  
Mateo Betancourt-Cajiao ◽  
Yaset Caicedo ◽  
...  
Keyword(s):  
Vascular Injury ◽  
Primary Repair ◽  
Damage Control ◽  
Damage Control Surgery ◽  
Vascular Trauma ◽  
Surgical Approaches ◽  
Peripheral Vascular ◽  
Limb Perfusion ◽  
Injured Region ◽  
Definitive Repair

Peripheral vascular injuries are uncommon in civilian trauma but can threaten the patient’s life or the viability of the limb. The definitive control of the vascular injury represents a surgical challenge, especially if the patient is hemodynamically unstable. This article proposes the management of peripheral vascular trauma following damage control surgery principles. It is essential to rapidly identify vascular injury signs and perform temporary bleeding control maneuvers. The surgical approaches according to the anatomical injured region should be selected. We propose two novel approaches to access the axillary and popliteal zones. The priority should be to reestablish limb perfusion via primary repair or damage control techniques (vascular shunt or endovascular approach). Major vascular surgeries should be managed postoperatively in the intensive care unit, which will allow correction of physiological derangement and identification of those developing compartmental syndrome. All permanent or temporary vascular procedures should be followed by a definitive repair within the first 8 hours. An early diagnosis and opportune intervention are fundamental to preserve the function and perfusion of the extremity.

scholarly journals Pedicled omentum hepatorrhaphy in blunt hepatic trauma

2017 ◽  
Vol 4 (9) ◽  
pp. 3038 ◽  
Author(s):  
Bhavinder K. Arora ◽  
Rachit Arora ◽  
Akshit Arora
Keyword(s):  
Liver Injury ◽  
Motor Vehicle ◽  
Damage Control ◽  
Damage Control Surgery ◽  
Male Dominance ◽  
Active Bleeding ◽  
Haemodynamic Instability ◽  
Hepatic Trauma ◽  
Artery Ligation ◽  
Pedicled Omentoplasty

Background: The liver is the most common solid viscera injured in motor vehicle accidents. Advances in radiological diagnostic techniques and critical care have increasing trend towards the nonoperative management. Still operative management is needed if there is continuous bleed or haemodynamic instability. The omentum commonly known as policeman of abdomen as it reaches intra-abdominal injury site. It is known to adhere to the site of injury and seals it. It increases the vascularity and starts neoangiogenesis. This produces haemostasis and promotes wound healing.Methods: In this study 24 patients were managed by this technique of pedicled omentoplasty. These patients were in the age group of 22 to 42 years. There was male dominance, 22 patients were males (91.7%) while only 2 patients were females (8.3%). The use of omentum in packing is described here. The omentum is converted to a pedicled flap based on right omental artery by tailoring it. The active bleeding vessels can be ligated. The whole length of pedicled omentum is packed in liver cavity. Using liver sutures two or more sutures are applied for stabilization.Results: On exploration, the hepatic injury was assigned grade as per AAST liver injury scale. Out of 24 patients included in this study; two (8.33%) were grade I patients, three (12.5%) were grade II patients, nine (37.5%) were grade III patients and ten (41.67%) were grade IV patients. Patients with grade V and grade VI were dealt by perihepatic packing as damage control surgery were excluded from this study.Conclusions: Pedicled omentoplasty in blunt hepatic trauma can be used irrespective of the grade of liver injury. It should be used in combination with other procedures like debridement, segmental or unsegmental resection, control of active bleeding vessels, use of Pringles manoeuvre, selective hepatic artery ligation and even with deep mattress suturing. This helps in haemostasis, early healing and rapid recovery with minimum complications. 

Hepatic Compartment Syndrome Treated with Damage Control Surgery and Transarterial Embolization: A Case Report

2021 ◽  
Author(s):  
Motoo Fujita ◽  
Takeaki Sato ◽  
Kei takase ◽  
Tomomi Sato ◽  
Hajime Furukawa ◽  
...  
Keyword(s):  
Compartment Syndrome ◽  
Nonoperative Management ◽  
Damage Control ◽  
Transarterial Embolization ◽  
Damage Control Surgery ◽  
Surgical Decompression ◽  
Intraparenchymal Hemorrhage ◽  
Combination Strategy ◽  
Hemorrhage Control ◽  
Hepatocellular Damage

Abstract Background: Hepatic compartment syndrome (HCS) is a complication of nonoperative management in patients with blunt hepatic injury. Although decompression of elevated intrahepatic pressure through surgical exploration or drainage and hemorrhage control are required to manage this condition, evidence for such a management for this complication is insufficient. Herein, we report a pediatric patient treated with a planned combination strategy of surgical decompression with perihepatic packing to reduce intrahepatic pressure and subcapsular hemorrhage control as well as angioembolization to control intraparenchymal hemorrhage. Case presentation: A 12-year-old boy was referred to our emergency department 5 h after sustaining severe bruising in the upper abdomen in a traffic accident. Computed tomography (CT) showed an intraparenchymal hematoma in the right lobe of the liver; nonoperative management was selected based on stable hemodynamic status. Two days after the injury, he complained of severe abdominal pain and shock. CT showed an intraparenchymal and large subcapsular hematoma with right branch compression of the portal vein and extravasation of contrast material. Laboratory data showed progression of hepatocellular damage. We successfully managed this patient with a planned combination strategy of surgical decompression with perihepatic packing for reduction of intrahepatic pressure and subcapsular hemorrhage control, followed by angioembolization for control of intraparenchymal hemorrhage. Conclusion: Our study suggests that for the management of HCS, a planned combination strategy of damage control surgery and angioembolization is a therapeutic option.

Sign in / Sign up

Export Citation Format

Share Document