Grade IV blunt hepatic injury treated conservatively and successfully in a non-trauma centre: a case report

Management of blunt hepatic injury changed over the past three decades as a non-operative treatment is nowadays advocated by most in haemodynamically stable patients. We present the case of a young female patient with a high-grade blunt liver injury successfully treated in a non-trauma centre. She developed several complications secondary to the injury like a delayed bleeding, two different bilomas and a reactive pleural effusion requiring surgical expertise, interventional radiology, upper gastro-intestinal endoscopy and intensive care facilities. In the literature, the mortality and the morbidity rates for grade IV liver injuries respectively reach 16% and 39%. Because of potential delayed symptoms or signs and high complication rate, we think it should be appropriate to manage such a complex patient in a centre where at least above-mentioned specialities are available. Otherwise, a referral to a trauma centre should be a better option.

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Suicidal Behavior in Black South Africans

Crisis ◽

10.1027//0227-5910.24.1.24 ◽

2003 ◽

Vol 24 (1) ◽

pp. 24-28 ◽

Cited By ~ 17

Author(s):

Lourens Schlebusch ◽

Naseema B.M. Vawda ◽

Brenda A. Bosch

Keyword(s):

South African ◽

Suicidal Behavior ◽

Health Care Facilities ◽

South African Society ◽

South Africans ◽

The Past ◽

The People ◽

Care Facilities ◽

Black South Africans ◽

To Come

Summary: In the past suicidal behavior among Black South Africans has been largely underresearched. Earlier studies among the other main ethnic groups in the country showed suicidal behavior in those groups to be a serious problem. This article briefly reviews some of the more recent research on suicidal behavior in Black South Africans. The results indicate an apparent increase in suicidal behavior in this group. Several explanations are offered for the change in suicidal behavior in the reported clinical populations. This includes past difficulties for all South Africans to access health care facilities in the Apartheid (legal racial separation) era, and present difficulties of post-Apartheid transformation the South African society is undergoing, as the people struggle to come to terms with the deleterious effects of the former South African racial policies, related socio-cultural, socio-economic, and other pressures.

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Risk factors for liver abscess formation in patients with blunt hepatic injury after non-operative management

European Journal of Trauma and Emergency Surgery ◽

10.1007/s00068-013-0346-7 ◽

2013 ◽

Vol 40 (5) ◽

pp. 547-552 ◽

Cited By ~ 1

Author(s):

C.-P. Hsu ◽

S.-Y. Wang ◽

Y.-P. Hsu ◽

H.-W. Chen ◽

B.-C. Lin ◽

...

Keyword(s):

Risk Factors ◽

Liver Abscess ◽

Hepatic Injury ◽

Operative Management ◽

Abscess Formation ◽

Blunt Hepatic Injury ◽

Non Operative Management

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CANADA'S FAILURE

PEDIATRICS ◽

10.1542/peds.93.4.569 ◽

1994 ◽

Vol 93 (4) ◽

pp. 569-569

Author(s):

J. F. L.

Keyword(s):

Health Care ◽

New England ◽

Care Delivery ◽

Health Care Facilities ◽

User Fees ◽

Capital Expenditures ◽

The Past ◽

Care Facilities ◽

Dog Owners ◽

The Government

The direct costs of Canada's national health insurance are not as troublesome as the distortive effect they have on health care delivery. Health care facilities have been forced to cut back severely on their capital expenditures, thus depleting the availability of advanced medical equipment. As a result, many patients must seek advanced treatment elsewhere. According to a recent study reported in the New England Journal of Medicine, nearly one-third of Canada's doctors have sent patients outside the country for treatment during the past five years. About 10% of all British Columbia residents requiring cancer therapy have been sent to the U.S. In Toronto, because the government doesn't provide enough money for personnel, 3,000 beds have been removed from service, while thousands of patients are on waiting lists for admission. Even where advanced equipment is available, bureaucratic absurdities prevent proper use. According to the April issue of "Fraser Forum," dogs at York Central Hospital in metropolitan Toronto were able to get CAT scans immediately while humans were put on a waiting list. The reason? Canadian patients are not allowed to pay for CAT scans, and the procedure costs too much to operate more than a few hours a day for nonpaying customers. Dog owners, on the other hand, were permitted to pay to use it. The user fees paid by the dog owners allowed the machine to operate longer, thus more human patients could be scanned. When this information was released, instead of considering user fees for humans, the Canadian government banned the tests for dogs!

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Damage control surgery for grade IV blunt hepatic injury with multiple organ damage in a child: a case report

Surgical Case Reports ◽

10.1186/s40792-021-01348-8 ◽

2021 ◽

Vol 7 (1) ◽

Author(s):

Jun Soma ◽

Daisuke Ishii ◽

Hisayuki Miyagi ◽

Seiya Ishii ◽

Keita Motoki ◽

...

Keyword(s):

Negative Pressure ◽

Hepatic Injury ◽

Open Abdomen ◽

Damage Control ◽

Organ Damage ◽

Multiple Organ ◽

Negative Pressure Therapy ◽

Pressure Therapy ◽

Neurological Sequelae ◽

Blunt Hepatic Injury

Abstract Background Intra-abdominal hemorrhage caused by blunt hepatic injury is a major cause of morbidity and mortality in patients with abdominal trauma. Some of these patients require laparotomy, and rapid decision-making and life-saving surgery are essential. Damage control (DC) surgery is useful for treating children in critical situations. We performed this technique to treat an 8-year-old boy with grade IV blunt hepatic injury and multiple organ damage. This is the first report of the use of the ABTHERA Open Abdomen Negative Pressure Therapy System (KCI, now part of 3 M Company, San Antonio, TX, USA) for DC surgery to rescue a patient without neurological sequelae. Case presentation An 8-year-old boy was brought to the emergency department of our hospital after being run over by a motor vehicle. He had grade IV blunt hepatic injury, thyroid injury, and bilateral hemopneumothorax. Although he was hemodynamically stable, the patient’s altered level of consciousness, the presence of a sign of peritoneal irritation, and suspicion of intestinal injury led us to perform exploratory laparotomy. As part of a DC strategy, we performed gauze packing to control hemorrhage from the liver and covered the abdomen with an ABTHERA Open Abdomen Negative Pressure Therapy System to improve the patient’s general condition. Eighteen days after admission, the patient was diagnosed with a biliary fistula, which improved with percutaneous and external drainage. He had no neurological sequelae and was discharged 102 days after injury. Conclusion The DC strategy was effective in children with severe blunt hepatic injury. We opted to perform DC surgery because children have less hemodynamic reserve than adults, and we believe that using this strategy before the appearance of trauma triad of death could save lives and improve outcomes. During conservative management, it is important to adopt a multistage, flexible approach to achieve a good outcome.

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Management of blunt hepatic injury in children: usefulness of emergency transcatheter arterial embolization

Journal of Pediatric Surgery ◽

10.1016/j.jpedsurg.2004.01.011 ◽

2004 ◽

Vol 39 (4) ◽

pp. 651

Keyword(s):

Transcatheter Arterial Embolization ◽

Hepatic Injury ◽

Arterial Embolization ◽

Blunt Hepatic Injury

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SUCCESS IN ACADEMIC PHILOSOPHY: WHAT FEMALE STUDENTS AND JUNIOR ACADEMICS NEED TO KNOW

Think ◽

10.1017/s1477175621000257 ◽

2021 ◽

Vol 20 (59) ◽

pp. 133-142

Author(s):

Rebecca Roache

Keyword(s):

Young Female ◽

Female Students ◽

The Past ◽

Academic Philosophy ◽

Male Dominated ◽

Important Progress

Despite some important progress over the past decade, academic philosophy remains a male-dominated discipline. This raises questions about how established philosophers can best support and advise female students and junior academics in philosophy. We need to avoid encouraging them to adopt a fatalistic attitude to their success (‘Philosophy is sexist, I'll never make it’), while also avoiding encouraging them to believe that their success lies in their own hands and that therefore it must be their own fault if they don't succeed. I argue that we can do this by reflecting on what success in a misogynistic culture looks like, and by guiding young female philosophers to distinguish between the changes that it is possible for them, as individuals, to make, and those that require action by many individuals.

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Biloma: A Delayed Complication of Blunt Hepatic Injury

Journal of Emergency Medicine ◽

10.1016/j.jemermed.2007.04.025 ◽

2008 ◽

Vol 34 (1) ◽

pp. 33-35 ◽

Cited By ~ 2

Author(s):

Rory Howard ◽

Samiksha Bansal ◽

Imtiaz A. Munshi

Keyword(s):

Hepatic Injury ◽

Blunt Hepatic Injury ◽

Delayed Complication

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Management of blunt hepatic injury in children: usefulness of emergency transcatheter arterial embolization

Pediatric Surgery International ◽

10.1007/s00383-002-0889-x ◽

2003 ◽

Vol 19 (1) ◽

pp. 29-34 ◽

Cited By ~ 24

Author(s):

Y. Ohtsuka ◽

K. Iwasaki ◽

S. Okazumi ◽

H. Yoshida ◽

T. Matsunaga ◽

...

Keyword(s):

Transcatheter Arterial Embolization ◽

Hepatic Injury ◽

Arterial Embolization ◽

Blunt Hepatic Injury

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Collagen, fibrinogen and thrombin biological addesive is effective in treating experimental liver injuries

Revista do Colégio Brasileiro de Cirurgiões ◽

10.1590/0100-69912016004004 ◽

2016 ◽

Vol 43 (4) ◽

pp. 254-261 ◽

Cited By ~ 2

Author(s):

FREDERICO MICHELINO DE OLIVEIRA ◽

MARCUS VINÍCIUS H. DE CARVALHO ◽

EVALDO MARCHI ◽

CLÓVIS ANTÔNIO LOPES PINTO

Keyword(s):

Lower Incidence ◽

Hepatic Injury ◽

Traumatic Injury ◽

Absorbable Suture ◽

Adhesive Material ◽

Histological Changes ◽

Liver Injuries ◽

Group A ◽

Group B ◽

Experimental Liver

ABSTRACT Objective : to evaluate the effectiveness of a collagen-based adhesive associated with fibrinogen and thrombin in experimental liver injury in rats. Methods : the study included 30 Wistar rats randomly divided into three groups: A, B and C. All underwent standard liver traumatic injury. In group A the lesion was treated with the adhesive; in group B, with conventional absorbable suture; and in group C, there was no treatment. We analyzed the time of hemostasis, mortality, occurrence of adhesions and any histological changes. Results : there was no statistical difference in relation to mortality (p = 0.5820). The group treated with the adhesive showed the lowest hemostasis times (p = 0.0573, odds ratio 13.5) and lower incidence of adhesions (p = 0.0119). Microscopic histological alterations of Groups A and B were similar, with foreign body granuloma formation separating the adhesive material or the suture from the hepatic stroma. Conclusion : the adhesive of collagen associated with fibrinogen and thrombin was effective in the treatment of experimental hepatic injury, providing a lower incidence of adhesions between the liver and surrounding structures.

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