Surgical Management of Complex Liver Trauma: A Single Liver Transplant Center Experience

2012 ◽  
Vol 78 (1) ◽  
pp. 20-25 ◽  
Author(s):  
Sergio Li Petri ◽  
Salvatore Gruttadauria ◽  
Duilio Pagano ◽  
Gabriel J. Echeverri ◽  
Fabrizio Di Francesco ◽  
...  
Keyword(s):  
Liver Resection ◽  
Liver Injury ◽  
Damage Control ◽  
Length Of Hospital Stay ◽  
Operative Management ◽  
Liver Trauma ◽  
Organ Injury ◽  
Transplant Center ◽  
Liver Injuries ◽  
Mechanism Of Trauma

Complex liver trauma often presents major diagnostic and management problems. Current operative management is mainly centered on packing, damage control, and early utilization of interventional radiology for angiography and embolization. In this retrospective observational study of patients admitted to the Mediterranean Institute for Transplantation and Advanced Specialized Therapies, Palermo, Italy, from 1999 to 2010, we included patients that underwent hepatic resection for complex liver injuries (grade I to Vaccording to the American Association for the Surgery of Trauma-Organ Injury Scale). Age, gender, mechanism of trauma, type of resection, surgical complications, length of hospital stay, and mortality were the variables analyzed. A total of 53 adult patients were admitted with liver injury and 29 underwent surgical treatment; the median age was 26.7 years. Mechanism was blunt in 52 patients. The overall morbidity was 30 per cent, morbidity related to liver resection was 15.3 per cent. Mortality was 2 per cent in the series of patients undergoing liver resection for complex hepatic injury, whereas in the nonoperative group, morbidity was 17 per cent and mortality 2 per cent. Liver resection should be considered a serious surgical option, as initial or delayed management, in patients with complex liver injury and can be accomplished with low mortality and liver-related morbidity when performed in specialized liver surgery/transplant centers.

scholarly journals Decreased mortality, laparotomy, and embolization rates for liver injuries during a 13-year period in a major Scandinavian trauma center

2018 ◽  
Vol 3 (1) ◽  
pp. e000205 ◽  
Author(s):  
Iver Anders Gaski ◽  
Jorunn Skattum ◽  
Adam Brooks ◽  
Tomohide Koyama ◽  
Torsten Eken ◽  
...  
Keyword(s):  
Injury Severity ◽  
Damage Control ◽  
Operative Management ◽  
University Hospital ◽  
Organ Injury ◽  
Level Of Evidence ◽  
Similar Reduction ◽  
Total Study Population ◽  
Treatment Protocols ◽  
Liver Injuries

BackgroundAlthough non-operative management (NOM) has become the treatment of choice in hemodynamically normal patients with liver injuries, the optimal management of Organ Injury Scale (OIS) grades 4 and 5 injuries is still controversial. Oslo University Hospital Ulleval (OUHU) has since 2008 performed angiography only with signs of bleeding. Simultaneously, damage control resuscitation was implemented. Would these changes result in a decreased laparotomy rate and need for angioembolization (AE), as well as decreased mortality?MethodsWe performed a retrospective study on all adult patients with liver injuries admitted at OUHU between 2002 and 2014. The total study population and patients with OIS grades 4 and 5 liver injuries underwent comparison between the periods before (P1) and after (P2) August 1, 2008.Results583 patients were included (P1: 237, P2: 346), with a median Injury Severity Score (ISS) of 29. The total population and the subgroup of OIS 4 and 5 injuries were comparable in age, gender, mechanism of injury, injury severity and physiology. Overall laparotomy rates decreased from P1 to P2 (35%–24%; p<0.01), as did the AE rate (11%–5%; p<0.01). The 30-day crude mortality decreased from 14% to 7% (p<0.05). A logistic regression model predicted an OR of 0.45 (95% CI 0.21 to 0.98) for dying when admitted in P2. In OIS grades 4 and 5 injuries (n=149, median ISS 34), similar reduction in AE rate was seen (30%–12%; p<0.05). The NOM rate for OIS grades 4 and 5 injuries was 70%, with 98% success rate. For the 30% requiring surgery, the mortality remained high (P1 52%; P2 40%), despite more balanced transfusion strategy.DiscussionChanges in resuscitation and treatment protocols were associated with decreased laparotomy, and AE rates as well as overall mortality. NOM is safe in 70% of patients with OIS grades 4 and 5 injuries, in contrast to the critically ill 30% requiring surgery who still have poor outcome.Level of evidenceIV.

scholarly journals Povrede jetre - nasa iskustva u tretmanu

2010 ◽  
Vol 57 (1) ◽  
pp. 101-106
Author(s):  
G. Vukovic ◽  
B. Stefanovic ◽  
G. Kaljevic ◽  
V. Vukojevic ◽  
V. Resanovic ◽  
...  
Keyword(s):  
Liver Injury ◽  
Damage Control ◽  
Damage Control Surgery ◽  
Liver Trauma ◽  
Young Population ◽  
Liver Injuries ◽  
Critical Patients ◽  
Care Problems ◽  
Isolated Liver ◽  
Standard Strategy

Background: Trauma is one of today's most serious and expensive health care problems, and it is the most common cause of mortality in young population. Non-operative treatment is standard strategy for management of blunt liver injuries in hemodynamically stable patients in last decade. Methods: Retrospective study included patients with liver trauma, admitted in the period december 1995-december 2005, in total 476. Results: 392 of 476 patients presenting with liver trauma had blunt and only 84 had penetrating injury. Isolated liver injury was identified in 27,5% and 72,5% had associated injuries. Average ISS value was 24.06 (SD=14.26). During the operation liver injury in patients was classified according to Moor. In 2% critical patients, due to hemodynamic unstability we performed 'damage control surgery'. Out of 476 patients 87,% were successfully managet, 6,1% died as 'mors in tabula' or during first 24 hours and 6,9% died during hospitalization. Conclusion: Higher proportion of nonoopertively treated is among patients with ISS less than and those with injuries grade I end II.

scholarly journals Damage Control in Penetrating Liver Trauma: Fear of the Unknown

2020 ◽  
Author(s):  
Carlos Alberto Ordoñez ◽  
Michael Parra ◽  
Mauricio Millan ◽  
Yaset Caicedo ◽  
Monica Guzman ◽  
...  
Keyword(s):  
Damage Control ◽  
Damage Control Surgery ◽  
Operative Management ◽  
Hemodynamic Instability ◽  
Liver Trauma ◽  
Solid Organ ◽  
Severely Injured ◽  
Management Algorithm ◽  
Liver Injuries ◽  
Non Operative Management

The liver is the most commonly affected solid organ in cases of abdominal trauma. Management of penetrating liver trauma is a challenge for surgeons but with the introduction of the concept of damage control surgery accompanied by significant technological advancements in radiologic imaging and endovascular techniques, the focus on treatment has changed significantly. The use of immediately accessible computed tomography as an integral tool for trauma evaluations for the precise staging of liver trauma has significantly increased the incidence of conservative non-operative management in hemodynamically stable trauma victims with liver injuries. However, complex liver injuries accompanied by hemodynamic instability are still associated with high mortality rates due to ongoing hemorrhage. The aim of this article is to perform an extensive review of the literature and to propose a management algorithm for hemodynamically unstable patients with penetrating liver injury, via an expert consensus. It is important to establish a multidisciplinary approach towards the management of patients with penetrating liver trauma and hemodynamic instability. The appropriate triage of these patients, the early activation of an institutional massive transfusion protocol, and the early control of hemorrhage are essential landmarks in lowering the overall mortality of these severely injured patients. To fear is to fear the unknown, and with the management algorithm proposed in this manuscript, we aim to shed light on the unknown regarding the management of the patient with a severely injured liver.

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 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.

scholarly journals Classification of Liver Trauma

HPB Surgery ◽  
1996 ◽  
Vol 9 (4) ◽  
pp. 235-238 ◽  
Author(s):  
Sandro B. Rizoli ◽  
Frederick D. Brenneman ◽  
Sherif S. Hanna ◽  
Kamyar Kahnamoui
Keyword(s):  
Classification Scheme ◽  
American Association ◽  
Liver Trauma ◽  
Trauma Centre ◽  
Organ Injury ◽  
Trauma Patients ◽  
Liver Injuries ◽  
The Mean ◽  
Related Mortality

The classification of liver injuries is important for clinical practice, clinical research and quality assurance activities. The Organ Injury Scaling (OIS) Committee of the American Association for the Surgery of Trauma proposed the OIS for liver trauma in 1989. The purpose ofthe present study was to apply this scale to a cohort ofliver trauma patients managed at a single Canadian trauma centre from January 1987 to June 1992.170 study patients were identified and reviewed. The mean age was 30, with 69% male and a mean ISS of 33.90% had a blunt mechanism ofinjury. The 170 patients were categorized into the 60IS grades ofliver injury. The number of units of blood transfused, the magnitude of the operative treatment required, the liver-related complications and the liver-related mortality correlated well with the OIS grade. The OIS grade was unable to predict the need for laparotomy or the length of stay in hospital. We conclude that the OIS is a useful, practical and important tool for the categorization of liver injuries, and it may prove to be the universally accepted classification scheme in liver trauma.

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.

scholarly journals Management of Traumatic Liver Injury in a Tertiary Care Hospital in Nepal

2020 ◽  
Vol 17 (4) ◽  
pp. 537-542
Author(s):  
Harish Chandra Neupane ◽  
Kishor Kumar Tamrakar ◽  
Abhishek Bhattrai ◽  
Tseten Yonjen Tamang ◽  
Bishnu Bista ◽  
...  
Keyword(s):  
Liver Injury ◽  
Operative Management ◽  
Treatment Modalities ◽  
Low Grade ◽  
Solid Organ ◽  
Care Hospital ◽  
Liver Injuries ◽  
Group A ◽  
Group B ◽  
Isolated Liver

Background: The liver is most frequently injured solid organ in abdominal trauma. The non-operative management is the standard treatment for hemodynamically stable patients. This study analyse the epidemiological aspects, injury patterns, treatment modalities and outcome in patients with liver injuries only and associated injuries outside the liver.Methods: This was a retrospective study in patients with liver injuries admitted from 1st March 2014 to 31st January 2019 at Chitwan Medical College and Hospital, Nepal. The patients were divided into two groups. Group A consisted of isolated liver injury and Group B liver injury with associated injury of other organs. Data were analysed by using descriptive statistics and Mann-Whitney U test.Results: A total of 61 patients were admitted with liver injury. There were 18 (29.5 %) patients with liver injury alone (group A) and 43 (70.5 %)liver injury associated with other organs (group B). Low grade liver injuries were 48 (78.7 %) and high grade 13 (21.3 %). The operative management was done for one liver injury with biliary peritonitis in group A. In group B, 16 patients required laparotomy and operative management for associated abdomen injuries.Conclusions: Non-operative treatment modality in hemodynamically stable patients with isolated liver injuries was safe and effective.Keywords: Liver injury; management; scoring; trauma.

scholarly journals New hemostatic device for grade IV–V liver injury in porcine model: a proof of concept

2019 ◽  
Vol 14 (1) ◽  
Author(s):  
Juan José Segura-Sampedro ◽  
Cristina Pineño-Flores ◽  
Andrea Craus-Miguel ◽  
Rafael Morales-Soriano ◽  
Francesc Xavier González-Argente
Keyword(s):  
Liver Injury ◽  
Porcine Model ◽  
Hypovolemic Shock ◽  
Liver Trauma ◽  
Severe Liver ◽  
New Device ◽  
Liver Injuries ◽  
Classic Technique ◽  
Negative Side Effects ◽  
The One

Abstract Background The liver is the most injured organ following abdominal trauma. Uncontrolled bleeding remains the main cause of early liver injury-related death, with a mortality rate of 50–54% in the first 24 h after admission and with 80% of operative deaths. Packing and reoperation account for the increased survival in severe liver trauma, and they are recommended for severe liver injuries (grades IV–V). Perihepatic packing can lead to several potential complications. An excessive packing can cause complications due to abdominal compartment syndrome, while a soft packing may be ineffective, and thus, bleeding can continue inadvertently with the consequent hypovolemic shock and potentially death. Methods We designed a new vacuum-based device to perform perihepatic packing without the negative side-effects of the classic technique. We conducted a prospective pilot feasibility study in a porcine model. We compared the traditional perihepatic packing (PHP) (n = 2) with the new VacBagPack device (VBP) (n = 2). Results Both pigs survived with the new device and showed an equivalent outcome to the one that survived in the traditional technique group. Blood tests were similar too. This suggests that VBP could be at least as effective as traditional PHP. Conclusions We establish a first step towards the development of a new packing device. A new study with a bigger sample size still in pigs will be conducted. Also, an industrial model of the device is currently in production.

Injuries Associated with Pediatric Liver Trauma

2007 ◽  
Vol 73 (1) ◽  
pp. 37-41 ◽  
Author(s):  
John A. Deluca ◽  
Damian R. Maxwell ◽  
Sarah K. Flaherty ◽  
Jason M. Prigozen ◽  
Mary E. Scragg ◽  
...  
Keyword(s):  
Liver Injury ◽  
Injury Severity ◽  
Liver Trauma ◽  
Childhood Mortality ◽  
Associated Injuries ◽  
Injury Management ◽  
Pediatric Liver ◽  
Liver Injuries ◽  
Average Patient ◽  
High Index Of Suspicion

Injury remains the leading cause of childhood mortality for children younger than 14 years of age, with the liver being particularly susceptible to blunt trauma in children. This study reviews the authors’ institutions’ experience with pediatric liver injuries in an attempt to establish current patterns of injury, management and outcomes. A single-center, retrospective review was conducted of 105 consecutive pediatric patients who presented with a traumatic liver injury from January 1996 through February 2004. Average patient age was 13.1 ± 4.9 years and 58 per cent were male. Perihospital mortality was 8.6 per cent, with 67 per cent of mortality being attributed to head injury. The majority of patients were managed nonoperatively (81%). Liver injury was most often grade II (35%) by CT scan. Liver injury grade did not affect survival, but did affect injury management, with grade I and grade IV liver injuries more likely to be managed surgically ( P < 0.001). Grade I liver injuries were associated with concomitant spleen injuries, whereas grade IV injuries were associated with pancreatic injuries. Surgical management was associated with a higher injury severity score ( P = 0.005), higher mortality ( P = 0.01), and with other associated injuries as well. Children experiencing blunt abdominal trauma are at risk of significant morbidity and mortality; however, these risks stem more likely from associated injuries than injury to the liver proper. Clinicians should maintain a high index of suspicion for potentially catastrophic associated injuries to the pancreas with high-grade liver injury.

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