Non-operative management of blunt hepatic injury in multiply injured adult patients

Objective: To diagnose the cases of hepatic injury due to blunt abdominal trauma in a shortest possible time and find out the way of efficient and planned management of hepatic injury in our present setting. Materials and methods: This study was done in the casualty department of Dhaka Medical College Hospital and 50 patients of hepatic injury following blunt abdominal trauma were selected over a period of January 2010 to December 2010. All 50 patients were admitted within 24 hours of incidence. The patients were diagnosed clinically by history and physical examination and relevant investigations. Immediately after admission patients were resuscitated by clearance of airway, maintenance of respiration, arrest of external bleeding and maintenance of normal circulation (ATLS Protocol). After resuscitation further management was planned depending upon the condition of the patient. Clinical presentation, overall management and outcome were evaluated by the available resources of casualty ward of DMCH. Results: Most patients were male (88%) and 68% of patients were belonged to age group of 21 to 40 years. Most of the patients (90%) were injured as a result of road traffic accidents. All patients had a history of trauma and most of them presented with abdominal pain, tenderness muscular rigidity of abdomen and shock (38%). Only 13 (26%) patients had isolated hepatic injury. Rest of the patients had associated other organ injuries. Majority patients (46%) had Grade-I hepatic injury. Out of 50 patients, 46 were operated and most of them had other intra abdominal organ injuries and 4 patients were given non-operative management. Suture hepatorrhaphy was done in 38 (76%) cases. Most common post operative complications were pulmonary in origin (24%) and three patients were died in this series. Conclusion: Simple technique of hemostasis such as suture hepatorrhaphy is sufficient in most cases with adequate drainage and non operative management can be tried based on haemodynamic stability. J Dhaka Medical College, Vol. 27, No.1, April, 2018, Page 57-61

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Presentation and Management of Hepatic Injury due to Blunt Trauma in Patients Attending in Casualty Block of dmch- a Study of 50 cases

Journal of Dhaka Medical College ◽

10.3329/jdmc.v25i2.33981 ◽

2017 ◽

Vol 25 (2) ◽

pp. 133-137

Author(s):

Mohammad Mahfuzur Rahman Chowdhury ◽

SM Amjad Hossain ◽

Salma Sultana ◽

Rifat Zaman ◽

Md Alauddin ◽

...

Keyword(s):

Abdominal Trauma ◽

Blunt Abdominal Trauma ◽

Traffic Accidents ◽

Hepatic Injury ◽

Road Traffic ◽

Operative Management ◽

College Hospital ◽

Medical College ◽

History Of ◽

Non Operative Management

Objective: To diagnose the cases of hepatic injury due to blunt abdominal trauma in a shortest possible time and find out the way of efficient and planned management of hepatic injury in our present setting.Materials and methods: This study was done in the casualty department of Dhaka Medical College Hospital and 50 patients of hepatic injury following blunt abdominal trauma were selected over a period of January 2010 to December 2010. All 50 patients were admitted within 24 hours of incidence. The patients were diagnosed clinically by history and physical examination and relevant investigations. Immediately after admission patients were resuscitated by clearance of airway, maintenance of respiration, arrest of external bleeding and maintenance of normal circulation (ATLS Protocol). After resuscitation further management was planned depending upon the condition of the patient. Clinical presentation, overall management and outcome were evaluated by the available resources of casualty ward of DMCH.Results: Most patients were male (88%) and 68% of patients were belonged to age group of 21 to 40 years. Most of the patients (90%) were injured as a result of road traffic accidents. All patients had a history of trauma and most of them presented with abdominal pain, tenderness muscular rigidity of abdomen and shock (38%). Only 13 (26%) patients had isolated hepatic injury. Rest of the patients had associated other organ injuries. Majority patients (46%) had Grade-I hepatic injury. Out of 50 patients, 46 were operated and most of them had other intra abdominal organ injuries and 4 patients were given non-operative management. Suture hepatorrhaphy was done in 38 (76%) cases. Most common post operative complications were pulmonary in origin (24%) and three patients were died in this series.Conclusion: Simple technique of hemostasis such as suture hepatorrhaphy is sufficient in most cases with adequate drainage and non operative management can be tried based on haemodynamic stability.J Dhaka Medical College, Vol. 25, No.2, October, 2016, Page 133-137

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Non-Operative Management of Isolated Blunt Hepatic Trauma - An Observational Study

Journal of Evidence Based Medicine and Healthcare ◽

10.18410/jebmh/2020/510 ◽

2020 ◽

Vol 7 (43) ◽

pp. 2463-2469

Author(s):

Waseem Ahmad Dar ◽

Shaukat Jeelani ◽

Umer Mushtaq ◽

Asgar Aziz Baba ◽

Farzanah Nowreen ◽

...

Keyword(s):

Observational Study ◽

Blunt Trauma ◽

Operative Management ◽

Liver Trauma ◽

Hepatic Trauma ◽

Female Ratio ◽

Medical College ◽

Blunt Hepatic Injury ◽

And Gender ◽

Non Operative Management

BACKGROUND Blunt trauma is one of the most serious and most common causes of death in youth. Specifically, liver is one of the most frequently injured organs during abdominal trauma. During the last two decades, management of blunt trauma to the liver has changed from mainly operative intervention, to the current practice of selective operative and non-operative management (NOM). Avoidance of a laparotomy with its short- and long-term risks is of great benefit to the patient. Majority of patients admitted for liver injury have grade I, II and III injuries and are successfully treated with non-operative management. METHODS We conducted a prospective observational study over a period of 24 months between August 2017 and August 2019 among a total of 48 patients, in the Department of General Surgery, Government Medical College, Srinagar, and associated hospitals who were haemodynamically stable with isolated blunt hepatic trauma. RESULTS As liver trauma occurs more frequently in men, we found that male to female ratio was 3 : 1. In our study, 97 % of patients with isolated blunt hepatic trauma were haemodynamically stable, rest 3 % patients stabilized after initial resuscitation. Most of the complications 14.58 % occurred in higher grade injuries (grade IV and V). The complication rate in our study group was 18.75 %. CONCLUSIONS About 90 % of haemodynamically stable patients with isolated blunt hepatic injury can be managed successfully by non-operative management and nonoperative management is the treatment of choice irrespective of the grade of injury, mode of blunt trauma, age, and gender. KEYWORDS Non Operative Management, Hepatic Trauma

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