Blunt Liver Injury in Children and Adults: Is There Really a Difference?

2008 ◽  
Vol 74 (9) ◽  
pp. 798-801 ◽  
Author(s):  
W. Patrick Klapheke ◽  
Glen A. Franklin ◽  
David S. Foley ◽  
Steven R. Casos ◽  
Brian G. Harbrecht ◽  
...  
Keyword(s):  
Liver Injury ◽  
Trauma Center ◽  
Nonoperative Management ◽  
Adult Population ◽  
Adult Patients ◽  
High Grade ◽  
Blunt Liver Injury ◽  
Liver Injuries ◽  
Related Mortality ◽  
Overall Mortality

Hepatic injuries are increasingly managed nonoperatively with the availability of adjunctive procedures such as angiography, ERCP, and percutaneous drainage. Although extensively discussed in the adult population, little has been reported on outcomes and management of pediatric liver injury. Retrospective review of all patients with blunt liver injuries admitted to an adult Level I trauma center and pediatric trauma center within the same community was performed from 2004 to 2006. The necessity for operation, adjuncts to nonoperative management, and outcome were collected and compared for the pediatric (PED) (<18 years of age) versus the adult (≥18 years of age) injured patients. There were 389 liver injuries identified (PED = 90, adult = 299); 25 per cent of adult injuries were greater than or equal to grade III, while 23 per cent of PED injuries were high-grade injuries. Each group of patients had similar rates of primary operative intervention: adult patients (18%) versus PED patients (16%). Adjunctive therapies were rarely used in the PED patients with only one patient requiring a percutaneous drain and one patient undergoing ERCP twice. Conversely, the adult patient group required eight percutaneous drains, 15 angiograms, 6 ERCPs and 14 laparoscopic abdominal washout procedures. ICU and hospital LOS were 25 per cent and 33 per cent lower in the adult population for high-grade injuries. The overall mortality rates were similar at 7 per cent (PED) and 9 per cent (adult). Liver-related mortality was 50 per cent (3/6 deaths) in the PED group with no liver-related deaths in the adult group (27 deaths). Adult patients with blunt liver injury were no more likely to sustain high grade liver injuries than PED patients. Furthermore, adult and PED patients underwent similar rates of operative intervention and primary liver procedures. Adult patients used adjunctive measures as part of their nonoperative management more frequently, but both subsets had similar length of hospital stays and low overall mortality. A higher rate of liver-related mortality was seen in the PED population. Overall, PED patients seemed to sustain fewer liver related complications necessitating invasive procedures despite similar injury patterns.

scholarly journals Traumatic Intraparenchymal Pseudoaneurysm on Initial Imaging Predicts Injury Progression in Patients with Nonoperative Major Blunt Liver Injury

2017 ◽  
Author(s):  
Duraid Younan ◽  
T. Mark Beasley ◽  
Andrew Papoy ◽  
Geoffrey Douglas ◽  
Patrick Bosarge
Keyword(s):  
Liver Injury ◽  
Ct Scan ◽  
Management Plan ◽  
Liver Trauma ◽  
Imaging Data ◽  
Blunt Liver Injury ◽  
Negative Results ◽  
Liver Injuries ◽  
Injury Progression ◽  
Repeat Imaging

Abstract Objective: Identify factors that would predict which patients would benefit from repeat imaging after major blunt liver injury. Summary of Background Data: Most patients who present with hemodynamic stability and no evidence of peritonitis after blunt liver injury are successfully managed nonoperatively. Little information is available regarding the utility of reimaging major blunt liver injuries for patients who are managed nonoperatively. Methods: A retrospective review of patients admitted to a level I trauma center with major blunt liver injuries (AAST grades 3-5) was conducted. Inclusion criteria were those admitted from July 2012 to June 2014 with blunt liver trauma who survived the first 24 hours and underwent repeat imaging. Data included demographics, procedures performed and computerized tomography (CT) scan findings. Findings on the second CT scan were categorized as Unchanged, Worse, Improved, or Negative. Results: 128 patients had blunt major liver injuries; 66 patients underwent repeat imaging. The mean time to repeat CT was 1.95 days. On repeat CT 47 were "Unchanged", 3 "Worse", 14 "Improved" and 2 "Negative". Three patients underwent angiography. One required embolization of a pseudoaneurysm. In 63 patients (95%), the second CT did not change the management plan. The presence of a pseudoaneurysm was significantly related to a worsening of the second CT (p=0.0475). Patients with admission hematocrit (Hct) below 32% were more likely to have a worsened second CT (p=0.0370). Conclusions: A pseudoaneurysm on admission CT and Hct &lt;32% predict major liver injury progression suggesting that routine reimaging is warranted in this group.

Nonoperative management of blunt liver injury in hemodynamically stable versus unstable patients: a retrospective study

2018 ◽  
Vol 25 (6) ◽  
pp. 647-652 ◽  
Author(s):  
Koichi Inukai ◽  
Shuhei Uehara ◽  
Yoshiteru Furuta ◽  
Masanao Miura
Keyword(s):  
Retrospective Study ◽  
Liver Injury ◽  
Nonoperative Management ◽  
Blunt Liver Injury

Delayed celiotomy for the treatment of bile leak, compartment syndrome, and other hazards of nonoperative management of blunt liver injury

2003 ◽  
Vol 185 (5) ◽  
pp. 492-497 ◽  
Author(s):  
Robert Goldman ◽  
Monica Zilkoski ◽  
Richard Mullins ◽  
John Mayberry ◽  
Clifford Deveney ◽  
...  
Keyword(s):  
Liver Injury ◽  
Compartment Syndrome ◽  
Nonoperative Management ◽  
Bile Leak ◽  
Blunt Liver Injury

scholarly journals The impact of obesity on severity of solid organ injury in the adult population at a Level I trauma center

2019 ◽  
Vol 4 (1) ◽  
pp. e000318 ◽  
Author(s):  
Allen K Chen ◽  
David Jeffcoach ◽  
John C Stivers ◽  
Kyle A McCullough ◽  
Rachel C Dirks ◽  
...  
Keyword(s):  
Trauma Center ◽  
Pediatric Patients ◽  
Splenic Injury ◽  
Adult Population ◽  
Organ Injury ◽  
Solid Organ ◽  
Obese Patients ◽  
Solid Organ Injury ◽  
Liver Injuries ◽  
Level I

BackgroundThe obese (body mass index, BMI > 30) have been identified as a subgroup of patients in regards to traumatic injuries. A recent study found that high-grade hepatic injuries were more common in obese than non-obese pediatric patients. This study seeks to evaluate whether similar differences exist in the adult population and examine differences in operative versus non-operative management between the obese and non-obese in blunt abdominal trauma.MethodsPatient with trauma evaluated at an American College of Surgeons verified Level I trauma center from February 2013 to November 2016 were retrospectively reviewed. All patients aged >18 years with blunt mechanism of injury and a BMI listed in the trauma registry were included. Patients were excluded for incomplete data, including BMI or inability to grade hepatic or splenic injury. Data collected included age, gender, BMI, injury severity score, hospital length of stay, procedures on liver or spleen, and mortality. Organ injuries were scored using the American Association for the Surgery of Trauma grading scales, and were determined by either imaging or intraoperative findings. Obesity was classified as BMI > 30 compared with non-obese with BMI < 30.ResultsDuring the study period, 9481 patients were included. There were 322 spleen injuries and 237 liver injuries, with 64 patients sustaining both liver and splenic injuries. No differences existed in the percentage of high-grade hepatic or splenic injuries between the obese and non-obese. Obese patients with liver injuries were more likely to have procedural intervention than non-obese liver injuries and had higher rates of mortality. No differences were found in intervention for splenic injury between obese and non-obese.ConclusionsContrary to prior studies on adult and pediatric patients with trauma, this study found no difference between obese and non-obese patients in severity of solid organ injury after blunt abdominal trauma in the adult population. However, there was an increased rate of procedural intervention and mortality for obese patients with liver injuries.Level of Evidence3.

scholarly journals Gastrointestinal Anastomosis (GIA) Stapler as a safe and efficacious damage control tool for High-Grade Liver Injury in Hemodynamically Unstable Patient- A Case Report

2020 ◽  
Author(s):  
Sabah uddin Saqib ◽  
Wafa Iftekhar ◽  
Hasnain Zafar
Keyword(s):  
Liver Injury ◽  
Damage Control ◽  
Active Bleeding ◽  
Gastrointestinal Anastomosis ◽  
Surgical Intensive Care Unit ◽  
High Grade ◽  
Unstable Patient ◽  
Liver Injuries ◽  
Life Threatening ◽  
Stapler Device

Abstract Background: Liver injury occurs in approximately 5% of all trauma admissions. The large size of the liver and its location makes it more susceptible to injuries. Nowadays, the majority of isolated liver injuries are successfully managed with non-operative methods, however, operative management is still the mainstay of treatment for hemodynamically unstable patients. There are many traditional ways of controlling hemorrhage from the liver and here we report a case in which a GIA 75 stapler was successfully used to manage Grade IV liver injury in a hemodynamically unstable patient.Case presentation: 45 years old policeman presented in the emergency, within 20 minutes after sustaining a gunshot injury to his abdomen. At presentation, he was hemodynamically unstable with a heart rate of 100 beats/min and blood pressures of 70/35 mm Hg. On examination, he had a single entry wound in the epigastrium with no exit wound and had generalized peritonitis. He was paraplegic and had a sensory level. He was rushed to the operating room (OR) for exploratory laparotomy which revealed a shattered left lobe of the liver. Gastrointestinal anastomosis 75 stapler device was used for non-anatomical left segmentectomy (segments I and II). Active bleeding from tributaries of left hepatic vein and small branches opening into retrohepatic inferior vena cava (IVC) was identified and the vessels were suture ligated. Perihepatic packing was done and the patient shifted to the surgical intensive care unit(SICU). His improved hemodynamically and was re-explored within 24 hours. No active bleeding was seen after the packs were removed and the abdomen was closed. The next day he was moved out of SICU and the rehabilitation program was initiated for his spine injury. He was discharged on the 10th day of admission.Discussion: Grade IV liver injuries are often very complex and challenging to manage in a hemodynamically unstable patient. The role of GIA staplers for hepatic resection is quite common and safe in elective settings but their similar use in the context of trauma is less described. The concept of damage control surgery rests on quick control of life-threatening bleeding and a GIA stapler can be effectively used for rapid non-anatomical resection of the liver in trauma. This can prevent the depletion of physiological reserves and the life-threatening death triad. Conclusion: GIA stapler device is an effective, safe, and rapidly deployable tool for managing high grade live injury in a hemodynamically unstable patient. It controls bleeding without any concomitant chances of bile leak and also resection of the shattered liver gives good access for inspecting the rest of the bleeding sites.

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.

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