scholarly journals P7 A review of the understanding and use of the Regional Liver Trauma Guidelines

BJS Open ◽  
2021 ◽  
Vol 5 (Supplement_1) ◽  
Author(s):  
Rohan Thakkar ◽  
Khaled Ammar ◽  
Ellen Meredith ◽  
Michael Jones ◽  
Ellen Meredith ◽  
...  
Keyword(s):  
Regional Distribution ◽  
Bile Leak ◽  
Operative Management ◽  
Liver Trauma ◽  
Trauma Patients ◽  
North East ◽  
The North ◽  
Close Observation ◽  
Patient’S Outcome ◽  
Non Operative Management

Abstract Introduction The liver is the most commonly injured intra-abdominal organ and occurs in 30% of patients undergoing laparotomy for penetrating injuries and in 15–20% of laparotomies for blunt injuries. CT scan is the investigation of choice for accurate diagnosis and categorization of hepatic injury. Management of isolated liver trauma can be by operative or non-operative management, guided mainly by haemodynamic stability of the patient irrespective to category of injury. Close observation of patients undergoing non-operative management is important; they may develop early complications that require operative intervention, including bleeding, bile leak and peritonitis. Methods A questionnaire will be sent to the General Surgery consultants and registrars within the North East of England, a region with eleven hospitals taking General Surgical admissions, two of which are regional trauma centres. This is to assess the understanding of liver trauma classification and management and their familiarity with and adherence to the regional liver trauma guidelines. Following this, the guidelines will be distributed throughout the region with accompanying teaching sessions. A follow up questionnaire will determine the improvement of regional knowledge and use of the guidelines. In parallel, the outcome of liver trauma patients within the region will be sought to look for correlation between the education and the patient’s outcome. Results Regional distribution of the results will demonstrate the change in the education of liver trauma management and the subsequent change in patient’s outcome. Results will be recorded using Excel and analysed using SPSS statistical software.

scholarly journals An Unusual Recurrent Bile Leak Following High Grade Liver Trauma

2021 ◽  
Vol 11 (3) ◽  
pp. 137-140
Author(s):  
Morgan E Jones ◽  
Ee Jun Ban ◽  
Charles H. C. Pilgrim
Keyword(s):  
Liver Injury ◽  
Endoscopic Retrograde Cholangiopancreatography ◽  
High Speed ◽  
Bile Leak ◽  
Biliary Tree ◽  
Operative Management ◽  
Liver Trauma ◽  
Post Injury ◽  
Endoscopic Retrograde ◽  
Non Operative Management

Non-operative management of blunt liver injury has been demonstrated as a safe and effective treatment for most grades of injury. As the severity of liver injury increases, so does the risk of complications. A 21-year-old male was brought to the trauma center following a high speed motorbike accident. He underwent a laparotomy and angioembolization for a Grade 4 liver injury. A biloma was diagnosed on Day 18 post injury, and he underwent Endoscopic Retrograde Cholangiopancreatography and biliary stenting which were unsuccessful. There were 2 re-admissions for infected perihepatic collections. In this case, an Endoscopic Retrograde Cholangiopancreatography was not a helpful procedure due to a disconnected liver segment, and morbidity occurred due to instrumentation of the biliary tree (the likely cause of infected biloma). Hepatic resection should be considered for patients who fail non-operative management. Further assessment of efficacy using a larger dataset for analysis is required.

Non-Operative Management of Liver Trauma

2012 ◽  
Vol 158 (2) ◽  
pp. 85-95 ◽  
Author(s):  
C Swift ◽  
Jeff Garner
Keyword(s):  
Operative Management ◽  
Liver Trauma ◽  
Non Operative Management

Fifteen-Year Single-Center Experience of Biliary Complications in Liver Trauma Patients: Changes in the Management of Posttraumatic Bile Leak

2020 ◽  
Author(s):  
Stephen Stonelake ◽  
Sana Ali ◽  
Benjamin Pinkey ◽  
Evelyn Ong ◽  
Ravindar Anbarasan ◽  
...  
Keyword(s):  
Median Time ◽  
Bile Leak ◽  
Liver Trauma ◽  
Trauma Patients ◽  
Hepatobiliary Scintigraphy ◽  
Line Treatment ◽  
First Line ◽  
Leak Management ◽  
Bile Leaks ◽  
First Line Treatment

Abstract Introduction Management of posttraumatic bile leak has evolved over time in our unit, from endoscopic retrograde cholangiopancreatography (ERCP) stenting to intraperitoneal drainage (IPD) alone as first-line treatment for intraperitoneal bile leak. Materials and Methods Retrospective review of liver trauma patients from 2002 to 2017. Demographics, time and mode of diagnosis of bile leak, management, and outcome were analyzed of the box plot. Results In 118 patients, there were 28 traumatic bile leaks. Eighteen were free intraperitoneal and 10 were localized bilomas. The median time of diagnosis was 6 days following injury. The modes of diagnosis were preemptive hepatobiliary scintigraphy (18), computed tomography (CT) or ultrasound (7), and laparotomy (3). Free intraperitoneal biliary leak management included 11 IPD alone, 3 IPD plus ERCP, 2 IPD plus transcystic biliary stent (TBS), 1 operative cholangiogram, and 1 no intervention. Median time of IPD duration was 7 days (4–95) in IPD alone versus 14 days (6–40) in IPD + ERCP/TBS (p = 0.3). Median inpatient length of stay was 13 days (8–44) in IPD alone versus 12 days (8–22) in IPD + ERCP/TBS (p = 0.4). Conclusion Placement of IPD alone, as first-line treatment, is safe and effective in the management of intraperitoneal bile leaks, avoiding the costs and potential complications of ERCP.

scholarly journals Non-Operative Management for Renal and Splenic Trauma – A Case Report

2020 ◽  
Vol 13 (62) (2) ◽  
pp. 43-52
Author(s):  
Alexandru Georgian Lăculiceanu ◽  
Denis Anamaria Mereț ◽  
Ruxandra Rotaru ◽  
Mircea Daniel Hogea ◽  
Ioan Scârneciu
Keyword(s):  
Injury Severity ◽  
Left Kidney ◽  
Operative Management ◽  
Renal Trauma ◽  
Iliopsoas Muscle ◽  
Splenic Trauma ◽  
Trauma Patients ◽  
Packed Red Blood Cells ◽  
Grade Ii ◽  
Non Operative Management

Management of abdominal trauma has evolved over the past decades and most of trauma patients can be managed conservatively. This article demonstrates the effectiveness of non-operative management (NOM) in a patient with grade IV renal trauma and grade II splenic trauma that was treated in the urology department of Emergency Clinical County Hospital of Brasov after a car crash. Clinical examination showed bruises on the right shoulder and macroscopic haematuria that suggest renal trauma. The abdomen was spontaneously painles, no signs of acute abdomen but severe pain in the left lumbar area, with no additional relevant medical history. The CT scan revealed laceration of the valvular area of the left kidney, spleen contusion and retroperitoneal haematoma with contrast spreading in the iliopsoas muscle region, classifying renal trauma as stage IV and splenic trauma as stage II on American Association for the Surgery of Trauma injury scale. The trauma is classified as serious with an Injury Severity Score of 18, and Resciniti CT score of 2, therefore NOM is recommended. Despite high grade trauma, the patient was haemodynamically stable, with a heart rate of 90 bpm, blood pressure of 105/65 mmHg and haemoglobin of 10.4g/dl. Under constant observation and with the help of a multidisciplinary team, the therapeutic focus was directed on local protocol consisting of pharmacological treatment with fluid resuscitation, antibiotic therapy, analgesics, haemostatics, anticoagulant therapy and multiple blood transfusions consisting of fresh frozen plasma and packed red blood cells. Starting with day 6, the haemoglobin levels normalized, no further blood transfusion beeing necessary. The patient was discharged and didn’t developed complications in the following 6 months. The NOM in the case of grade IV renal trauma and a grade II splenic trauma  is effective, provided the patients are haemodynamically stable and constant reevaluations are performed.

scholarly journals 90 Penetrating Abdominal Trauma: Comperative Study Between Operative and Conservative Management

2021 ◽  
Vol 108 (Supplement_6) ◽  
Author(s):  
A Shalaby ◽  
M Ibrahim ◽  
T El Faioumy ◽  
M Elmessiry
Keyword(s):  
Abdominal Trauma ◽  
Operative Management ◽  
The Other ◽  
University Hospital ◽  
Organ Injury ◽  
Low Grade ◽  
Trauma Patients ◽  
Solid Organ ◽  
Penetrating Abdominal Trauma ◽  
Non Operative Management

Abstract Aim to Assess the feasibility and safety of selective non-operative management in penetrating abdominal injuries and to identify a protocol for selection of patient’s candidates for non-operative management. Method In this comparative study 40 abdominal stab victims (admitted to Emergency Department of Alexandria Main University Hospital) were selected during 6 months period where 20 patients were suitable for non-operative management according to strict selection criteria whereas the other 20 patients were operated according to clinical and/or radiological indications or on basis of department protocol, the results were compared in view of final outcome. Results In our study, 15 patients were assigned for operative management according to selected clinical and/or radiological indications only 3 of them (20%) had non-therapeutic laparotomies, On the other hand, five patients were explored on basis of department protocol in violation of our indications for exploration; four of them (80%) were non-therapeutic. So, the rate of non-therapeutic laparotomies was significantly higher when done mandatory without selected clinical and radiological indications. Conclusions Assessment of vital signs together with abdominal examination are the most important and dependable tools in decision making in penetrating abdominal trauma patients. Patients with shock on admission (but responding to resuscitation), proved low grade solid organ injury (by CT), and proved intraperitoneal collection (by US or CT) could be managed conservatively regarding that they remain vitally and clinically stable. If failure of conservation occurs, it is usually during the 1st 24 hours after admission.

scholarly journals Lactate clearance: its relationship with the success of non-operative management in patient with blunt abdominal trauma

2017 ◽  
Vol 4 (5) ◽  
pp. 1738
Author(s):  
Reno Rudiman ◽  
Nova Saragih ◽  
Andriana Purnama
Keyword(s):  
Hemorrhagic Shock ◽  
Abdominal Trauma ◽  
Blunt Abdominal Trauma ◽  
Operative Management ◽  
Lactate Clearance ◽  
Trauma Patients ◽  
Solid Organ ◽  
Chi Square ◽  
History Of ◽  
Non Operative Management

Background: Occult ongoing bleeding has become the second highest cause of death in blunt abdominal trauma. Undetected abdominal injury has caused morbidity and mortality in patients at the early phases of trauma. Non-operative Management (NOM) in solid organ trauma is safe and effective, and this strategy has become widely used. Lactate clearance (LC) has important clinical benefits in patients with acute trauma that is superior to initial lactate examination.  Methods: This study was a prospective cohort study of patients with history of hemorrhagic shock caused by blunt abdominal trauma that came to emergency room of Hasan Sadikin Hospital Bandung from August 2015 to July 2016. The tests were including initial blood lactate, 2 hours, and 4 hours post-resuscitation and then calculation of LC. Analysis using SPSS with chi square for the significance of relationships and Spearman correlation to determine the strength of the relationship between variables. Comparison test between LC2 and LC4 were calculated using Mann-Whitney tests.Results: During one year period, from August 2015 to July 2016, there were 34 patients. Age was in the range of 15-65 years, with a range of 15-25 years were 19 (55.8%), 25-50 years were 11 (32.4%), and >50 years as many as four (11.8%). By sex, there were 28 (82.4%) male gender and 6 (17.6%) women. Based on the type of trauma, there were 11 (32.4%) single trauma patients and 23 (67.6%) multiple trauma patients. Based on the results of statistical analysis with chi square, there was a significant correlation between lactate clearance 2 hours (LC2) and lactate clearance 4 hours (LC4) with the success of NOM (p <0.001) with the Odds Ratio (OR) are 3.750 and 6.500 respectively. Based on non-parametric test (Mann Whitney) showed that there were no significant differences between the LC2 and LC4 in determining the successful of NOM (p>0.05).Conclusions: There was a significant relationship between lactate clearance 2 hours (LC2) and lactate clearance 4 hours (LC4) in determining the success of non-operative management (NOM) in patients with history of hemorrhagic shock caused by blunt abdominal trauma. In addition, there are no significant differences between the LC2 and LC4 in determining the success of the NOM, so that either LC2 or LC4 may be used in predicting the success of NOM, as LC4 is the first preference. The low level of lactate clearance may be used as one of indicators to terminate non-operative management and proceed with surgery right before all symptoms of hemorrhagic shock arise.

Outcomes and indications for intervention in non-operative management of paediatric liver trauma: A 5 year retrospective study

2014 ◽  
Vol 69 (2) ◽  
pp. 157-162 ◽  
Author(s):  
R. Inchingolo ◽  
A. Ljutikov ◽  
A. Deganello ◽  
P. Kane ◽  
J. Karani
Keyword(s):  
Retrospective Study ◽  
Operative Management ◽  
Liver Trauma ◽  
Non Operative Management

Non-operative management of liver trauma

2012 ◽  
Vol 84 (6) ◽  
pp. 330-334
Author(s):  
A. Marinis ◽  
S. Rizos
Keyword(s):  
Operative Management ◽  
Liver Trauma ◽  
Non Operative Management

Regional distribution of styrene analogues generated from polystyrene degradation along the coastlines of the North-East Pacific Ocean and Hawaii

2014 ◽  
Vol 188 ◽  
pp. 45-49 ◽  
Author(s):  
Bum Gun Kwon ◽  
Katsuhiko Saido ◽  
Koshiro Koizumi ◽  
Hideto Sato ◽  
Naoto Ogawa ◽  
...  
Keyword(s):  
Pacific Ocean ◽  
Regional Distribution ◽  
North East ◽  
The North ◽  
East Pacific ◽  
East Pacific Ocean
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