scholarly journals Management modalities of isolated liver injury in blunt abdominal trauma

2019 ◽  
Vol 7 (1) ◽  
pp. 58
Author(s):  
Lalji Mangukiya ◽  
Hardik Astik
Keyword(s):  
Liver Injury ◽  
Abdominal Trauma ◽  
Blunt Abdominal Trauma ◽  
Road Traffic ◽  
Demographic Data ◽  
Standard Of Care ◽  
Operative Management ◽  
Treatment Morbidity ◽  
Injury Grade ◽  
Isolated Liver

Background: The liver is one of the most commonly injured organ in blunt abdominal trauma. Management of liver injury due to blunt abdominal trauma has been dramatically evolved in recent years. Dramatic change from operative management to non-operative management has improved survival in these patients, becoming the standard of care for most liver injuries.Methods: A retrospective study of the patients admitted with the diagnosis of isolated liver injury due to blunt abdominal trauma between 2013-2018. Data collected of 30 patients of isolated liver injury who either treated conservative management of operative management. Variable analyzed included demographic data, mechanism of injury, associated injury, conservative treatment, operative treatment, morbidity, mortality, and hospital stay.Results: A total of 30 patients were analyzed of isolated liver injury due to blunt abdominal trauma, 27 patient sustained minor liver injury (grade I, II and III), whereas 3 patients had major liver injury (grade IV, V and VI). 25 cases due to road traffic accident and 5 cases were due to falls from a height. 27 patients with American Association for the surgery of trauma grade I, II, III and 2 patients with grade IV, V managed conservatively, surgical intervention required in 1 patient with grade V, mortality occurred in 1 patient out of 29 who were treated conservatively.Conclusions: Isolated liver injury is common in the blunt abdominal trauma patient. Most of the patients with the liver injury with hemodynamically stable treated conservatively. Only a few of them require surgical management if they are hemodynamically unstable.

scholarly journals SPECTRUM OF BLUNT ABDOMINAL TRAUMA

2020 ◽  
Vol 4 (8) ◽  
Author(s):  
Ajay Pal ◽  
Indira . ◽  
L. K. Kapil
Keyword(s):  
Liver Injury ◽  
Abdominal Trauma ◽  
Blunt Abdominal Trauma ◽  
Traffic Accidents ◽  
Splenic Injury ◽  
Road Traffic ◽  
Age Groups ◽  
Operative Management ◽  
Initial Assessment ◽  
Cross Sectional

Background: Blunt abdominal trauma is a leading cause of morbidity and mortality among all age groups. Many injuries may not manifest during the initial assessment and treatment period. Methods: Hospital based cross-sectional study conducted at Trauma center and P.B.M Hospital, Bikaner Results: Distribution according to type of injury consisted of maximum cases, 86% of road traffic accidents 74 of which were male and 12 female. 10% cases were of fall from height, 6 were male and 4 female .Assault cases were 4%. Case distribution according to organ involved consisted of 54.00% cases of liver injury,18.00% cases were of splenic injury, 23.00% patients had ilial injury, Pancreatic injury occurred in 2patient. Conclusions: Males were pre-dominantly affected. Road traffic accident was the most common cause of injury. Though conservative management is successful in carefully selected patients, operative management remains the main stay of treatment. Keywords: Blunt abdominal trauma, Liver injury, Perforation, Splenic injury

scholarly journals SPECTRUM AND OUTCOME OF BLUNT ABDOMINAL TRAUMA IN A TEACHING HOSPITAL, BIKANER, RAJASTHAN

2019 ◽  
Vol 3 (7) ◽  
Author(s):  
Surendra Saini ◽  
Mahesh Joshi
Keyword(s):  
Liver Injury ◽  
Abdominal Trauma ◽  
Blunt Abdominal Trauma ◽  
Splenic Injury ◽  
Road Traffic ◽  
Age Groups ◽  
Operative Management ◽  
Initial Assessment ◽  
Assessment And Treatment ◽  
Case Distribution

Background: Blunt abdominal trauma is a leading cause of morbidity and mortality among all age groups. Many injuries may not manifest during the initial assessment and treatment period. Methods: Hospital based prospective study conducted at Dept. of General Surgery, S.P.Medical College and P.B.M Hospital, Bikaner Results: Case distribution according to organ involved consisted of 27 cases of liver injury 25 of these cases were managed conservatively , and only two were operated.18 cases were of splenic injury 16 of which were managed conservatively and two underwent surgery.    Conclusions: Males were pre-dominantly affected. Road traffic accident was the most common cause of injury. Though conservative management is successful in carefully selected patients, operative management remains the main stay of treatment. Keywords: Blunt abdominal trauma, Liver injury, Perforation, Splenic injury

scholarly journals Traumatic Liver Injury in Hong Kong: The Management Strategy and Outcome

2009 ◽  
Vol 16 (4) ◽  
pp. 208-216 ◽  
Author(s):  
CN Chong ◽  
YS Cheung ◽  
KF Lee ◽  
TH Rainer ◽  
BSP Lai
Keyword(s):  
Hong Kong ◽  
Liver Injury ◽  
Hospital Stay ◽  
Injury Severity ◽  
Road Traffic ◽  
Demographic Data ◽  
Operative Management ◽  
Concomitant Injuries ◽  
Significant Difference ◽  
Non Operative Management

Introduction Management of liver injury is challenging and evolving. The aim of this article is to review the outcome of traumatic liver injury in Chinese people in Hong Kong. Materials & methods Records of 40 patients with hepatic injury who received treatment at the Prince of Wales Hospital between December 2000 and May 2005 were reviewed. Demographic data, severity of liver injury, Injury Severity Score (ISS), haemodynamic status and Glasgow Coma Scale (GCS) score on admission, investigations made, concomitant injuries, management scheme, and outcome of patients were analysed. Results There were 23 male and 17 female patients with a mean age of 31.3 (SD=15.4) years. Road traffic accident was the most common injury mechanism (65%). Half of the patients were treated by non-operative management (NOM). None of them required surgery during subsequent management. Patients in the operative management (OM) group had a significantly higher ISS (p=0.026), but there was no significant difference in the mortality rate between the OM and NOM groups. Patients with stable haemodynamic status and who were treated non-operatively had a significantly shorter hospital stay (p=0.006). High grade liver injury (OR=8.0, 95% CI=1.2 to 53.8, p=0.03) and ISS greater than 25 (OR=21.6, 95% CI=2.0 to 225.3, p=0.01) were independent risk factors for mortality on multivariate analysis. Conclusions Non-operative management of liver injury can be safely accomplished in haemodynamically stable patients, with the possible benefit of a shorter hospital stay.

scholarly journals SPECTRUM AND OUTCOME OF BLUNT ABDOMINAL TRAUMA

2020 ◽  
Vol 4 (1) ◽  
Author(s):  
Mahesh Kumar Sharma ◽  
Dr. Arun Bhargava
Keyword(s):  
Abdominal Trauma ◽  
Blunt Abdominal Trauma ◽  
Traffic Accident ◽  
Traffic Accidents ◽  
Splenic Injury ◽  
Road Traffic ◽  
Age Groups ◽  
Operative Management ◽  
Fall From Height ◽  
Type Of Injury

Background: Blunt abdominal trauma is a leading cause of morbidity and mortality among all age groups. So we evaluate the spectrum and outcome of blunt trauma. Methods: Hospital based prospective study conducted on 100 patients at department of general surgery. Results: Distribution according to type of injury consisted of maximum cases, 84 (84%) of road traffic accidents, 11% cases were of fall from height. Conclusions: Males were pre-dominantly affected. Road traffic accident was the most common cause of injury. Though conservative management is successful in carefully selected patients, operative management remains the main stay of treatment. Keywords: Blunt abdominal trauma, Liver injury, Perforation, Splenic injury

Operative Intervention for Complete Pancreatic Transection in Children Sustaining Blunt Abdominal Trauma: Revisiting an Organ Salvage Technique

2011 ◽  
Vol 77 (5) ◽  
pp. 612-620 ◽  
Author(s):  
Matthew J. Borkon ◽  
Stephen E. Morrow ◽  
Elizabeth A. Koehler ◽  
Yu Shyr ◽  
Melissa A. Hilmes ◽  
...  
Keyword(s):  
Abdominal Trauma ◽  
Blunt Abdominal Trauma ◽  
Injury Severity ◽  
Demographic Data ◽  
Operative Management ◽  
Pancreatic Injury ◽  
Pancreatic Tissue ◽  
Management Algorithm ◽  
Lengths Of Stay ◽  
Pancreatic Transection

Complete pancreatic transection (CPT) in children is managed commonly with distal pancreatectomy (DP). Alternatively, Roux-en-Y distal pancreaticojejunostomy (RYPJ) may be performed to preserve pancreatic tissue. The purpose of this study was to review our experience using either procedure in the management of children sustaining CPT after blunt abdominal trauma. We retrospectively reviewed the records of all children admitted to our institution during the last 15 years who were confirmed at operation to have CPT after blunt mechanisms. Summary statistics of demographic data were performed to describe children receiving either RYPJ or DP. CPT occurred in 28 children: 15 had DP, 10 had RYPJ, and three had cystogastrostomy. RYPJ children, compared with DP, were younger (7.5 vs 12.3 years, P = 0.039) and sustained more grade IV pancreatic injuries (70% vs 14%, P = 0.01). DP patients were 5.63 times more likely to tolerate full enteral feeds ( P = 0.009). Nevertheless, when controlling for age, injury severity score, and pancreatic injury grade, procedure type did not statistically affect total and postoperative lengths of stay and postoperative complications. In the operative management algorithm of children sustaining CPT, DP may afford an earlier return to full enteral feeds. RYPJ seems otherwise equivalent to DP and preserves significant pancreatic glandular tissue and the spleen.

scholarly journals A prospective and retrospective study on conservative management of hepatic and splenic injury following blunt abdominal trauma

2020 ◽  
Vol 7 (6) ◽  
pp. 1930
Author(s):  
Induchoodan Ponnamma Pillai Sukumaran Nair ◽  
Rajesh P. S.
Keyword(s):  
Abdominal Trauma ◽  
Conservative Management ◽  
Blunt Abdominal Trauma ◽  
Motor Vehicle ◽  
Motor Vehicle Accident ◽  
Road Traffic ◽  
Operative Management ◽  
Splenic Trauma ◽  
Solid Organ ◽  
Non Operative Management

Background: worldwide road traffic accidents accounts as the leading cause of death of young people. For a very long time most of the intra-abdominal injuries following blunt abdominal trauma were managed operatively. Conservative management is becoming more acceptable and effective management option for blunt abdominal trauma during the last few decades.Methods: This study was conducted in Government Medical College, Kottayam during September 2007 to December 2008. All conservatively managed blunt abdominal trauma patients during the study period were included in the study.Results: Out of 22 patients, 4 patients failed conservative management. Success rate was 81%. Most commonly injured solid organ in the study group was liver (77%). Maximum cases were of age group 10 to 20 (31.81%) years. 81% of patients were males. Motor vehicle accident was the most common cause of trauma (77%). Mean stay in intensive care unit was 4.2 days and mean hospital stay was 15.7 days. Mean systolic blood pressure was 110 mmHg ranging from 70 to 130 mmHg. 50% of patients had moderate hemoperitoneum and non-had massive hemoperitoneum.Conclusions: Non operative management is safe and effective approach in blunt spleen and liver injuries. Non operative management should be treatment of choice for all hemodynamically stable patients with blunt liver and splenic trauma.

scholarly journals Presentation and Management of Hepatic Injury due to Blunt Trauma in Patients Attending in Casualty Block of DMCH - A Study of 50 Cases

2018 ◽  
Vol 27 (1) ◽  
pp. 57-61
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. 27, No.1, April, 2018, Page 57-61

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

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

scholarly journals ANALYSIS OF BLUNT ABDOMINAL TRAUMA CASES AT TERTIARY CARE HOSPITAL BIKANER (RAJASTHAN)

2021 ◽  
Vol 5 (6) ◽  
Author(s):  
Deepak Singh Panwar ◽  
Ashok Kumar
Keyword(s):  
Abdominal Trauma ◽  
Blunt Abdominal Trauma ◽  
Traffic Accidents ◽  
Road Traffic ◽  
Tertiary Care ◽  
Operative Management ◽  
Care Hospital ◽  
Young Males ◽  
Medical College ◽  
Blunt Abdominal Injury

Background: In view of increasing number of vehicles and consequently road traffic accidents, this dissertation has been chosen to study the cases of blunt abdominal trauma with reference to the patients presenting at P.B.M. hospital, attached to S.P. Medical College, Bikaner. Methods: Prospective hospital-based study was conducted on all the patients of blunt abdominal injury admitted in the department of surgery, S.P. Medical College and P.B.M. Hospital, Bikaner. Results: Majority of the patients presented with abdominal pain (86%) and abdominal tenderness (81%). Conclusion: We concluded that young Males are predominantly affected.  Road traffic accident forms the most common mode of injury.  Though conservative management is successful in carefully selected patients, operative management remains the main stay of treatment. Keywords: Blunt trauma, Age, Sex

scholarly journals Role of Liver Enzymes in Patients with Blunt Abdominal Trauma to Diagnose Liver Injury

2020 ◽  
Author(s):  
Anup Shrestha ◽  
Harish Chandra Neupane ◽  
Kishor Kumar Tamrakar ◽  
Abhishek Bhattarai ◽  
Gaurav Katwal
Keyword(s):  
Liver Injury ◽  
Confidence Interval ◽  
Ct Scan ◽  
Abdominal Trauma ◽  
Blunt Abdominal Trauma ◽  
Predictive Value ◽  
Liver Enzymes ◽  
Tertiary Center ◽  
Significant Difference

Abstract Background:The liver is the second most injured organ following blunt abdominal trauma (BAT) after spleen. Although the computed tomography (CT) scan is considered as the gold standard for diagnosing liver injury in BAT, it is not readily available in the hospital. This study was performed to evaluate the role of aspartate transaminase (AST) and alanine transaminase (ALT) in patients with BAT and its significance in predicting the diagnosis and severity of the liver injury.Method:The study was conducted in Chitwan Medical College Teaching Hospital (CMCTH) study from February 2019 to May 2020. During that period 96 patients with BAT presented to the emergency department(ED) of CMCTH.Results:Among the 96 patients admitted with BAT, 38 patients had liver injury and 58 patients had no liver injury. The median length of the intensive care unit (ICU) stay of patients with liver injury was higher than without liver injury. There was a significant difference in the median level of AST and ALT (<0.001) between patients with liver injury and no liver injury. The area under the ROC curve of AST was 0.89(95% Confidence Interval 0.86-0.98) and of ALT was 0.92(95% Confidence Interval 0.83-0.97). The area under the curve demonstrated that the test was a good predictor for the identification of liver injury and also the severity of liver enzymes. The cut-off values for the liver injury were 106 U/l and 80 U/l for AST and ALT respectively. Based on these values, AST ≥ 106 U/l had a sensitivity of 71.7 %, a specificity of 90 %, a positive predictive value of 86.8 %, and a negative predictive value of 77.6 %. The corresponding values for ALT ≥ 80 U/l were 77.8 %, 94.1%, 92.1% and 82.8 %, respectively.ConclusionIn conclusion, we report the optimal cut-off value of AST and ALT for liver injury in BAT as ≥ 106 U/l and 80 U/l respectively. The elevated level of AST and ALT might assist the surgeons to timely refer the suspected patients with the liver to a tertiary center and it might help the surgeons to go for conservative management for minor liver injuries in BAT preventing the exposure hazards of the CT scan.

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