scholarly journals Hepatic Trauma Interventions

2021 ◽  
Vol 38 (01) ◽  
pp. 096-0104
Author(s):  
Akshita S. Pillai ◽  
Girish Kumar ◽  
Anil K. Pillai
Keyword(s):  
Liver Injury ◽  
Cause Of Death ◽  
Abdominal Trauma ◽  
Penetrating Trauma ◽  
Liver Trauma ◽  
Solid Organ ◽  
Hepatic Trauma ◽  
Blunt Abdominal Injury ◽  
Large Size ◽  
Uncontrolled Bleeding

AbstractThe liver is the second most commonly involved solid organ (after spleen) to be injured in blunt abdominal trauma, but liver injury is the most common cause of death in such trauma. In patients with significant blunt abdominal injury, the liver is involved approximately 35 to 45% of the time. Its large size also makes it a vulnerable organ, commonly injured in penetrating trauma. Other than its position and size, the liver is surrounded by fragile parenchyma and its location under the diaphragm makes it vulnerable to shear forces during deceleration injuries. The liver is also a vascular organ made of large, thin-walled vessels with high blood flow. In severe hepatic trauma, hemorrhage is a common complication and uncontrolled bleeding is usually fatal. In fact, in patients with severe abdominal trauma, liver injury is the primary cause of death. This article reviews the clinical presentation of patients with liver injury, the grading system for such injuries that is most frequently used, and management of the patient with liver trauma.

Early surgical management of severe liver trauma with vascular complication can lead to early discharge

Trauma ◽  
2020 ◽  
Vol 22 (3) ◽  
pp. 233-236
Author(s):  
Ee Jun Ban ◽  
Belinda Hii ◽  
Marty Smith ◽  
Warren Clements
Keyword(s):  
Bile Duct ◽  
Liver Injury ◽  
Early Discharge ◽  
Vascular Complication ◽  
Liver Trauma ◽  
Multidisciplinary Management ◽  
Hepatic Trauma ◽  
Severe Liver ◽  
Portal Triad ◽  
Arterial Embolisation

Intrahepatic arterio-portal fistulas are rare complications of blunt hepatic trauma. We describe a case of a 35-year-old male sustaining blunt abdominal trauma resulting in a grade IV liver injury complicated by arterio-portal fistula, portal venous pseudoaneurysm and concomitant bile duct injury. Although arterial embolisation is the mainstay of treatment for arterio-portal fistula, we describe a rationale for early involvement of a hepatobiliary surgeon for multidisciplinary management. Hepatic resection for acute hepatic trauma can, in selected cases, promptly manage all elements of portal triad injury, and in this particular case facilitated early uncomplicated discharge.

scholarly journals Control of Hemorrhage in Liver Trauma

2020 ◽  
Vol 4 (1) ◽  
Author(s):  
Skender Buci ◽  
Dorina Shtjefni ◽  
Arben Gjata ◽  
Gjovalin Bushi ◽  
Sonja Saraçi Butorac
Keyword(s):  
Liver Resection ◽  
Liver Injury ◽  
Foley Catheter ◽  
Survival Rates ◽  
Surgical Techniques ◽  
Penetrating Trauma ◽  
Pringle Maneuver ◽  
Liver Trauma ◽  
Artery Ligation ◽  
Study Results

Background: Control of hemorrhage in major liver trauma constitutes an ongoing surgical challenge even in nowadays, as surgeons often face difficult situations in its management. The goal of this study was to analyze our experience in the control of hemorrhage in major liver trauma. Materials and methods: Our study was performed prospectively covering a period of time from January 2009 till December 2012. 173 patients with liver trauma were included in our study. Results: Temporary haemostasis maneuvers in the setting of urgent laparotomy consisted of: bimanual compression 13 patients (15.3%), Pringle maneuver 23 patients (27%), perihepatic packing 10 patients (11,8%), Foley catheter balloon tamponade 2 patients (2.4%), intrahepatic tamponade in penetrating trauma 4 patients (4.7%). Definitive haemostasis methods used in urgent laparotomy were: electro-coagulation of the liver injury 12 patients (14.1%), haemostasis and biliostasis followed by hepatic closure 41 patients (48.2%), haemostasis and biliostasis without hepatic closure 6 patients (7.1%), tamponade with a pedicled vascularized omental flap (pedicled omentum hepatorrhaphy) 7 patients (8.2%), anatomic liver resection 1 patient (1.2%), nonanatomic/atypical liver resection 7 patients (8.2%), right hepatic artery ligation 1 patient (1.2%). Surgical techniques in preplanned laparotomies consisted of: left hepatectomy 1 patient (16.6%), right hepatectomy 1 patient (16,6%), nonanatomic/atypical liver resections 4 patients (66.7%). The success of treatment was significantly related to the grade of liver injury (z= 5.2912, p=<0.00001), other concomitant abdominal organ injuries (z=4.0743, p=0.00005), amount of blood transfusion received (p=0.03207), and age (p=0.04944). Overall mortality rate was 13%. Conclusion: Perihepatic packing and performing the surgical intervention in two sessions has significantly improved survival rates in major liver trauma from our experience.

scholarly journals Management of solid organ injury in patient of blunt abdominal trauma

2021 ◽  
Vol 8 (8) ◽  
pp. 2361
Author(s):  
Aafrin S. Baldiwala ◽  
Vipul C. Lad
Keyword(s):  
Cause Of Death ◽  
Abdominal Trauma ◽  
Blunt Abdominal Trauma ◽  
Road Traffic ◽  
Correct Diagnosis ◽  
Organ Injury ◽  
Common Mechanism ◽  
Free Fluid ◽  
Solid Organ ◽  
Initial Resuscitation

Background: In this ongoing era of 21st century, trauma is the leading cause of death in individuals between age 1 and 44. In trauma, also road traffic accidents (RTAs) are the major cause of death. Blunt abdominal trauma is a frequent emergency and is associated with significant morbidity and mortality.Methods: A prospective analysis of 50 patients of blunt abdominal trauma admitted in SMIMER hospital Surat within a span of 12 months was done. Unstable patients with initial resuscitation underwent focused assessment sonography for trauma (FAST). Failed resuscitation with free fluid in abdomen confirmed by FAST immediately shifted to operation theatre for laparotomy and proceed. Hemodynamically stable patients underwent computerized tomography of abdomen.Results: Most of the patients in our study were in the age group of 21-45 years with M:F ratio of 4:1. RTAs (62%) was the most common mechanism of injury. Spleen (38%) was the commonest organ injured and the most common surgery performed was splenectomy. In total non-operative management (NOM) was done in 58% of cases and surgical management was done in 42% of cases.Conclusions: Appropriate patient selection, early diagnosis and repeated clinical examination and use of appropriate investigations forms the key in management of blunt abdominal trauma. To conclude, initial resuscitation measures and correct diagnosis forms the most vital part of blunt abdominal trauma management.

scholarly journals Isolated gallbladder perforation in paediatric blunt abdominal injury: A case report and review of literature

2021 ◽  
Vol 7 (2) ◽  
pp. 103-107
Author(s):  
Sujoy Neogi ◽  
Arka Banerjee ◽  
Shasanka S Panda ◽  
Simmi K Ratan
Keyword(s):  
Abdominal Trauma ◽  
Blunt Abdominal Trauma ◽  
Diagnostic Laparoscopy ◽  
Road Accident ◽  
Organ Injury ◽  
Current Evidence ◽  
Gallbladder Perforation ◽  
Free Fluid ◽  
Solid Organ ◽  
Blunt Abdominal Injury

Gallbladder injury in blunt abdominal trauma is rare, around 2% of all abdominal traumas. Vague symptoms and inconclusive imaging make it an elusive diagnosis, more so in children. Only 30 pediatric cases have been reported worldwide till date. We report a case of a 7yrs old boy presenting 2 weeks after a road accident with a gallbladder rupture which was eventually discovered on a diagnostic laparoscopy. This is the second such case being reported from India. The injury is most often identified at exploration and although cholecystectomy is the preferred treatment, there are occasions when the gallbladder may be left in situ. The classification system of Losanoff and Kjossev has merit in guiding treatment. The various presentations, mechanisms and modes of injury have been highlighted along with the clinical and imaging findings. Despite the developments in modern radiology, identifying gallbladder perforation has always been difficult because of the rarity of the condition. In a child with blunt abdominal trauma and intra-abdominal free fluid without any solid organ injury, a diagnostic peritoneal tap may be helpful. Based on the current evidence, we advocate a low threshold for performing a diagnostic laparoscopy in all such cases.

scholarly journals Studying the clinical profile of blunt hepatic trauma

2021 ◽  
Vol 8 (3) ◽  
pp. 869
Author(s):  
Vijay Pal ◽  
Bhavinder Kumar Arora ◽  
Rohit Singh ◽  
Gourav Mittal ◽  
Monika Shekhawat ◽  
...  
Keyword(s):  
Abdominal Trauma ◽  
Conservative Management ◽  
Traffic Accidents ◽  
Road Traffic ◽  
Operative Management ◽  
Significant Shift ◽  
Solid Organ ◽  
Hepatic Trauma ◽  
Blunt Hepatic Injury ◽  
Surgery Department

Background: The liver is the largest intra-abdominal organ and is considered to be the second commonest organ to be injured in blunt abdominal trauma. Blunt hepatic injuries due to road traffic accidents are the sixth leading cause for death in India. Approximately 15-20% of abdominal injury presents as hepatic trauma and is liable for 50% of death resulting from abdominal trauma. The mortality rate is higher with blunt hepatic trauma than penetrating injuries. The advent of improved and expeditious imaging technologies amid advances in critical-care monitoring, prompted a significant shift towards conservative management of solid-organ abdominal injuries.Methods: The study was conducted over 96 patients in General Surgery Department, PGIMS, Rohtak with a history of blunt hepatic injury. The study duration was from 16th May 2018 till 1st June 2020. The aim of the study was to evaluate the pattern of blunt hepatic trauma and the patterns with which they presented in the emergency department.Results: In this study, 98.96% of the patients were managed conservatively whereas only 1.04% of patients needed surgical intervention. Conservative approach was possible because of strict patient monitoring, availability of experienced surgeons and radiologists, good intensive care unit care.Conclusions: The study concluded that conservative management of the patient is better than operative management and can be done in the patients who are hemodynamically stable. Most of the patients settle after 48 hours if managed conservatively.  

scholarly journals Outcomes of surgical management of liver trauma at LUMHS Jamshoro

2020 ◽  
Vol 8 (3) ◽  
pp. 1042
Author(s):  
Hamid R. Laghari ◽  
Zameer H. Laghari ◽  
Ambreen Munir ◽  
Shahid N. Memon ◽  
Qambar A. Laghari ◽  
...  
Keyword(s):  
Surgical Technique ◽  
Surgical Management ◽  
Bile Leak ◽  
Penetrating Trauma ◽  
Abdominal Sepsis ◽  
Liver Trauma ◽  
P Value ◽  
Trauma Patients ◽  
Hepatic Trauma ◽  
Recurrent Hemorrhage

Background: Mortality from liver trauma remains high despite surgical advancements. The objective of this study was to determine the outcomes of surgical management of liver trauma at LUMHS Jamshoro.Methods: A cross-sectional observational study using non-probability convenient sampling technique was done at department of surgery LUMHS Jamshoro for 18 months. Patients between 14 to 50 years with blunt hepatic trauma presenting to the E.R. within 04 hours of incident were included and hepatic trauma patients managed conservatively, having multiple trauma and hemo-dynamically stable were excluded. SPSS version 20 was used for data analysis with mean and SD reported for qualitative and frequency and percentages for quantitative variables. Chi-square test was applied keeping p-value of < 0.05 as statistically significant.Results: From 136 patients with mean age of 32.33±1.23 years, 120 (88%) were male. 122 (89.7%) were admitted due to blunt trauma and 14 (10.3%) due to penetrating trauma. Peri-hepatic packing was performed in 116 (85.2%) and suture hepatorrhaphy in 20 (14.8%). Intra-abdominal sepsis was seen in 41 (30%) of patients followed by recurrent hemorrhage in 33 (24%) while 30 (22%) of patients died. Substantial differences (p < 0.001) were observed in terms of surgical technique and each of the complication i.e. sepsis, bile leak and recurrent hemorrhage among alive patientsConclusions: The most common post-operative complication was intra-abdominal sepsis followed by recurrent haemorrhage and bile leak. Significant mortality was observed in between type of complication as well as surgical technique.

scholarly journals Evaluating the role of liver enzymes as predictors of severity of liver injury in patients with blunt abdominal trauma

2017 ◽  
Vol 5 (6) ◽  
pp. 2462
Author(s):  
Preetha Prasad ◽  
Abhijith Acharya ◽  
Gopi Ellikunnel Vithon ◽  
Girish N. M. Kumar
Keyword(s):  
Liver Injury ◽  
Abdominal Trauma ◽  
Blunt Abdominal Trauma ◽  
Liver Enzymes ◽  
Liver Trauma ◽  
Organ Injury ◽  
Contrast Enhanced Ct ◽  
Hepatic Transaminases ◽  
Contrast Enhanced ◽  
Enhanced Ct

Background: Liver is the 2nd most common organ affected in patients with blunt abdominal trauma (BAT). Computed tomography (CT) is the gold standard in the initial evaluation of the hemodynamically stable patient with suspected liver trauma. However, a challenge exists in centers devoid of CT scan, where an elevation in hepatic transaminases may provide guidance for the emergency physician in seeking further imaging and/or surgical consultation.Methods: In patients with suspected BAT blood samples were taken for estimation of liver enzymes (AST and ALT). All patients underwent contrast enhanced CT of the abdomen. Hemodynamically unstable patients were taken up for laparotomy and the findings were recorded. Based on imaging / surgery patients were subdivided into 2 groups (with and without liver injury). Liver injuries were graded according to organ injury scale by American Association of Surgery for Trauma.Results: ALT>100 units had 100% sensitivity and specificity improved to 83.78%. The mean level of ALT in patients without liver injury was around 64. This increased to 142 in grade 1 and upto 780 units in grade 4 injury. The same rising trend was seen when AST was evaluated against grade of Liver injury. This was statistically significant (p<0.01).Conclusions: ALT is the better of the transaminases in predicting liver injury. The rise in transaminases is directly proportional to grade of liver injury.

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 Start of Polytrauma Management in University Hospital: First Experience with Liver Trauma

2014 ◽  
Vol 14 (1) ◽  
pp. 20-25
Author(s):  
Solvita Stabina ◽  
Aleksejs Kaminskis ◽  
Guntars Pupelis
Keyword(s):  
Liver Injury ◽  
Cause Of Death ◽  
Nonoperative Management ◽  
Skull Fracture ◽  
Flail Chest ◽  
Young Patients ◽  
Liver Trauma ◽  
University Hospital ◽  
Traumatic Rupture ◽  
Liver Injuries

Summary Introduction. Trauma is a leading cause of death, particularly among young patients. Spleen is the most commonly damaged organ in blunt abdominal trauma and liver injury is the main cause of death. Aim of the study. Review of the literature and recent clinical experience in the management of blunt liver injuries in the Riga East clinical university hospital. Materials and methods. Three-year experience in the management of liver traumatic rupture was retrospectively and prospectively analysed. The study included 64 patients over 15 years of age with blunt hepatic injuries. Exclusion criteria were patients with life-incompatible haemorrhagic shock. The Statistical analysis of the data was performed by median and mean of the Microsoft Excel 2010 and SPSS 22 version. Results. A total of 64 patients were treated in our institution during the period from November 2010 till November 2013. Isolated liver injuries were diagnosed in 49 cases, combined liver and spleen injuries in 15 cases. Most commonly mechanism ofinjury were road traffic accidents, falls and low energy blunt traumas (criminal beaten, sports injuries);19 patients underwent laparotomy for haemostasis while nonoperative management was used in 45 patients. Haemodynamic stability of the patient and CT confirmed liver injury were the main criteria for nonoperative management. One patient died atthe time of laparotomy from injuries not compatible with life – severe head injury with basal skull fracture, aortic arc rupture, flail chest and liver and spleen injury. Conclusions. Conservative management of liver trauma is justified in haemodynamically(HD) stable patients after thorough risk assessment and computed tomography (CT) based injury grading in centres with sufficient expertise and medical resources.

Management of Hepatic Trauma: An Update

2018 ◽  
Vol 02 (02) ◽  
pp. 159-171
Author(s):  
Isaac Dahan ◽  
Vanessa Ho ◽  
Baljendra Kapoor ◽  
Min Lang
Keyword(s):  
Liver Injury ◽  
Abdominal Trauma ◽  
American Association ◽  
Operative Management ◽  
World Society ◽  
Grading System ◽  
Abdominal Organ ◽  
Hepatic Trauma

AbstractBeing the largest solid abdominal organ, the liver is the second most commonly injured organ after abdominal trauma. In this review, we discuss the American Association for the Surgery of Trauma's (AAST) liver injury grading system and World Society of Emergency Surgery's triage grading system. Furthermore, we discuss the role of imaging in hepatic trauma, as well as the indications, techniques, and roles of nonoperative and operative management.

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