Early Surgery in Prone Position for Associated Injuries in Patients Undergoing Non-operative Management for Splenic and Liver Injuries

The liver is one of the most commonly injured solid organs in blunt abdominal trauma. Non-operative management is considered to be the gold standard for the care of most blunt liver injuries. Angioembolization has emerged as an important adjunct that is vital to the success of the non-operative management strategy for blunt hepatic injuries. This procedure, however, is fraught with some possible serious complications. The success, as well as rate of complications of this procedure, is determined by degree and type of injury, hepatic anatomy and physiology, and embolization strategy among other factors. In this review, we discuss these important considerations to help shed further light on the contribution and impact of angioembolization with regards to complex hepatic injuries.

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Non-operative management of blunt liver injuries

British Journal of Surgery ◽

10.1002/bjs.1800780824 ◽

1991 ◽

Vol 78 (8) ◽

pp. 968-972 ◽

Cited By ~ 34

Author(s):

M. J. Hollands ◽

J. M. Little

Keyword(s):

Operative Management ◽

Liver Injuries ◽

Non Operative Management

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495 ANGIOGRAPHIC EMBOLIZATION AS AN ADJUNCNTIVE TREATMENT FOR THE NON-OPERATIVE MANAGEMENT OF PENETRATING LIVER INJURIES

Journal of Investigative Medicine ◽

10.2310/6650.2005.00005.494 ◽

2005 ◽

Vol 53 (1) ◽

pp. S164.6-S165

Author(s):

F. Banimahd ◽

S. Huerta ◽

M. Lekawa ◽

M. O. Dolich

Keyword(s):

Operative Management ◽

Angiographic Embolization ◽

Liver Injuries ◽

Non Operative Management

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Long-Term Follow-Up After Non-operative Management of Blunt Splenic and Liver Injuries: A Questionnaire-Based Survey

World Journal of Surgery ◽

10.1007/s00268-017-4336-5 ◽

2017 ◽

Vol 42 (5) ◽

pp. 1358-1363 ◽

Cited By ~ 2

Author(s):

Peter Moreno ◽

Matthias Von Allmen ◽

Tobias Haltmeier ◽

Daniel Candinas ◽

Beat Schnüriger

Keyword(s):

Operative Management ◽

Liver Injuries ◽

Long Term Follow Up ◽

Non Operative Management

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Management of acetabular fractures

10.1093/med/9780199550647.003.012049 ◽

2011 ◽

Author(s):

Berton R. Moed

Keyword(s):

Hip Joint ◽

Surgical Approach ◽

Joint Instability ◽

Operative Management ◽

Acetabular Fractures ◽

Treatment Goals ◽

Associated Injuries ◽

Experienced Surgeon ◽

Joint Congruity ◽

Non Operative Management

♦ Acetabular fracture patients often have associated injuries♦ Restoration of hip joint congruity and stability are the treatment goals♦ Stable concentrically reduced fractures can be considered for non-operative management♦ Operative treatment is indicated for fractures with hip joint instability or incongruity♦ Choosing the proper surgical approach is one of the most important treatment aspects♦ Although the surgery is demanding, an experienced surgeon can obtain excellent results.

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Selective non-operative management of penetrating liver injuries at a UK tertiary referral centre

Annals of The Royal College of Surgeons of England ◽

10.1308/003588414x13946184901524 ◽

2014 ◽

Vol 96 (6) ◽

pp. 423-426 ◽

Cited By ~ 15

Author(s):

P MacGoey ◽

A Navarro ◽

IJ Beckingham ◽

IC Cameron ◽

AJ Brooks

Keyword(s):

Phase Contrast ◽

Injury Severity ◽

Penetrating Trauma ◽

Operative Management ◽

Arterial Phase ◽

Haemodynamic Instability ◽

Tertiary Referral Centre ◽

Contrast Extravasation ◽

Liver Injuries ◽

Non Operative Management

Introduction Selective non-operative management (SNOM) of penetrating abdominal injuries has increasingly been applied in North America in the last decade. However, there is less acceptance of SNOM among UK surgeons and there are limited data on UK practice. We aimed to review our management of penetrating liver injuries and, specifically, the application of SNOM. Methods A retrospective review was performed of patients presenting with penetrating liver injuries between June 2005 and November 2013. Results Thirty-one patients sustained liver injuries due to penetrating trauma. The vast majority (97%) were due to stab wounds. The median injury severity score was 14 and a quarter of patients had concomitant thoracic injuries. Twelve patients (39%) underwent immediate surgery owing to haemodynamic instability, evisceration, retained weapon or diffuse peritonism. Nineteen patients were stable to undergo computed tomography (CT), ten of whom were selected subsequently for SNOM. SNOM was successful in eight cases. Both patients who failed SNOM had arterial phase contrast extravasation evident on their initial CT. Angioembolisation was not employed in either case. All major complications and the only death occurred in the operatively managed group. No significant complications of SNOM were identified and there were no transfusions in the non-operated group. Those undergoing operative management had longer lengths of stay than those undergoing SNOM (median stay 6.5 vs 3.0 days, p<0.05). Conclusions SNOM is a safe strategy for patients with penetrating liver injuries in a UK setting. Patient selection is critical and CT is a vital triage tool. Arterial phase contrast extravasation may predict failure of SNOM and adjunctive angioembolisation should be considered for this group.

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Liver injuries in children: The role of selective non-operative management

Injury ◽

10.1016/j.injury.2005.07.013 ◽

2006 ◽

Vol 37 (1) ◽

pp. 66-71 ◽

Cited By ~ 42

Author(s):

A. Landau ◽

A.B. van As ◽

A. Numanoglu ◽

A.J.W. Millar ◽

H. Rode

Keyword(s):

Operative Management ◽

Liver Injuries ◽

Non Operative Management

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Predictors of failure in non-operative management of blunt liver trauma

International Surgery Journal ◽

10.18203/2349-2902.isj20173870 ◽

2017 ◽

Vol 4 (9) ◽

pp. 2913 ◽

Cited By ~ 1

Author(s):

Andika A. Winata ◽

Reno Rudiman

Keyword(s):

Demographic Data ◽

Fluid Collection ◽

Transaminase Level ◽

Operative Management ◽

Nonoperative Treatment ◽

Liver Trauma ◽

Group I ◽

Liver Injuries ◽

Non Operative Management ◽

Blunt Liver Trauma

Background: Liver is the most injured organ in abdominal trauma. Nonoperative treatment (NOM) is increasingly being adopted as the initial management strategy. The aim of this study was to evaluate the results of operative and conservative management of patients with blunt liver injury treated in a single institution.Methods: A retrospective study, analyzing patients admitted from 2011-2015 with the diagnosis of liver trauma, was performed. The patients were classified according to the intention to treatment: Group I, NOM; Group II, operative management and Group III, fail in NOM management. We analyzed demographic data, injury classification, associated injuries, transfusions, shock, liver function test, lactate level, and mortality rates.Results: Over the five years period, 68 patients were recorded, 45 were successful (S-NOM) and 18 were failed (F-NOM). No differences in age, sex or initial hemodynamics were found between S-NOM and F-NOM. The F-NOM patients were more seriously injured, more acidotic, required transfusion, had more fluid collection at FAST, had worse transaminase level and higher mortality rate. Grade of liver injuries was the independent risk factor of failure in nonoperating management of blunt liver trauma with the cut-off point is 3.66.Conclusions: Non-operative management of blunt liver injuries is successful in some cases. Patients with more severe injury tend to have an operation. High-grade blunt liver injuries always present with a worse condition and require an operation.

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