Non-Operative Management of Isolated Blunt Hepatic Trauma - An Observational Study

2020 ◽  
Vol 7 (43) ◽  
pp. 2463-2469
Author(s):  
Waseem Ahmad Dar ◽  
Shaukat Jeelani ◽  
Umer Mushtaq ◽  
Asgar Aziz Baba ◽  
Farzanah Nowreen ◽  
...  
Keyword(s):  
Observational Study ◽  
Blunt Trauma ◽  
Operative Management ◽  
Liver Trauma ◽  
Hepatic Trauma ◽  
Female Ratio ◽  
Medical College ◽  
Blunt Hepatic Injury ◽  
And Gender ◽  
Non Operative Management

BACKGROUND Blunt trauma is one of the most serious and most common causes of death in youth. Specifically, liver is one of the most frequently injured organs during abdominal trauma. During the last two decades, management of blunt trauma to the liver has changed from mainly operative intervention, to the current practice of selective operative and non-operative management (NOM). Avoidance of a laparotomy with its short- and long-term risks is of great benefit to the patient. Majority of patients admitted for liver injury have grade I, II and III injuries and are successfully treated with non-operative management. METHODS We conducted a prospective observational study over a period of 24 months between August 2017 and August 2019 among a total of 48 patients, in the Department of General Surgery, Government Medical College, Srinagar, and associated hospitals who were haemodynamically stable with isolated blunt hepatic trauma. RESULTS As liver trauma occurs more frequently in men, we found that male to female ratio was 3 : 1. In our study, 97 % of patients with isolated blunt hepatic trauma were haemodynamically stable, rest 3 % patients stabilized after initial resuscitation. Most of the complications 14.58 % occurred in higher grade injuries (grade IV and V). The complication rate in our study group was 18.75 %. CONCLUSIONS About 90 % of haemodynamically stable patients with isolated blunt hepatic injury can be managed successfully by non-operative management and nonoperative management is the treatment of choice irrespective of the grade of injury, mode of blunt trauma, age, and gender. KEYWORDS Non Operative Management, Hepatic Trauma

scholarly journals Epidemiological evaluation of hepatic trauma victims undergoing surgery

2016 ◽  
Vol 43 (1) ◽  
pp. 22-27 ◽  
Author(s):  
Mitre Kalil ◽  
Isaac Massaud Amim Amaral
Keyword(s):  
Blunt Trauma ◽  
Damage Control ◽  
Penetrating Trauma ◽  
Damage Control Surgery ◽  
Liver Trauma ◽  
Metropolitan Region ◽  
Trauma Patients ◽  
Hepatic Trauma ◽  
Female Ratio ◽  
Packed Red Blood Cells

Objective : to evaluate the epidemiological variables and diagnostic and therapeutic modalities related to hepatic trauma patients undergoing laparotomy in a public referral hospital in the metropolitan region of Vitória-ES. Methods : we conducted a retrospective study, reviewing charts of trauma patients with liver injuries, whether isolated or in association with other organs, who underwent exploratory laparotomy, from January 2011 to December 2013. Results : We studied 392 patients, 107 of these with liver injury. The male: female ratio was 6.6 : 1 and the mean age was 30.12 years. Penetrating liver trauma occurred in 78.5% of patients, mostly with firearms. Associated injuries occurred in 86% of cases and intra-abdominal injuries were more common in penetrating trauma (p <0.01). The most commonly used operative technique was hepatorrhaphy and damage control surgery was applied in 6.5% of patients. The average amounts of blood products used were 6.07 units of packed red blood cells and 3.01 units of fresh frozen plasma. The incidence of postoperative complications was 29.9%, the most frequent being infectious, including pneumonia, peritonitis and intra-abdominal abscess. The survival rate of patients suffering from blunt trauma was 60%, and penetrating trauma, 87.5% (p <0.05). Conclusion : despite technological advances in diagnosis and treatment, mortality rates in liver trauma remain high, especially in patients suffering from blunt trauma in relation to penetrating one.

The Role of Angioembolization in Hepatic Trauma

2020 ◽  
pp. 000313482097372
Author(s):  
Ali Cadili ◽  
Jonathan Gates
Keyword(s):  
Gold Standard ◽  
Management Strategy ◽  
Operative Management ◽  
Hepatic Trauma ◽  
Anatomy And Physiology ◽  
Liver Injuries ◽  
Hepatic Injuries ◽  
Non Operative Management ◽  
Type Of Injury

The liver is one of the most commonly injured solid organs in blunt abdominal trauma. Non-operative management is considered to be the gold standard for the care of most blunt liver injuries. Angioembolization has emerged as an important adjunct that is vital to the success of the non-operative management strategy for blunt hepatic injuries. This procedure, however, is fraught with some possible serious complications. The success, as well as rate of complications of this procedure, is determined by degree and type of injury, hepatic anatomy and physiology, and embolization strategy among other factors. In this review, we discuss these important considerations to help shed further light on the contribution and impact of angioembolization with regards to complex hepatic injuries.

scholarly journals Solid organ injury in blunt trauma abdomen: an etiological evaluation and success rate of non-operative management

2018 ◽  
Vol 5 (4) ◽  
pp. 1350
Author(s):  
Ramachandra M. L. ◽  
Krishna S. R.
Keyword(s):  
Blunt Trauma ◽  
Surgical Management ◽  
Traffic Accidents ◽  
Road Traffic ◽  
Operative Management ◽  
Abdominal Injury ◽  
Organ Injury ◽  
Free Fluid ◽  
Road Traffic Accidents ◽  
Non Operative Management

Background: Trauma remains the most common cause of death for all individuals between the ages of 1 and 44 years. 10% of these fatalities are attributable to abdominal injury. The Indian fatality rates for trauma are 20 times that for developed countries. The management of patients with blunt abdominal injury has evolved greatly over the last few decades from complete surgical management historically to present non operative management in most of the cases. In view of increasing number of road traffic accidents, rampant increase in construction work, accidental fall from height, this study is conducted to look into the causes of such incidents and also to strengthen the already established rules of non operative management in cases of blunt trauma abdomen.Methods: This is a prospective study of 53 patients who presented to K. R. Hospital, Mysuru, Karnataka, for management of blunt trauma abdomen over the period of January 2016 to June 2017. Unstable patients with initial resuscitation underwent Focused Assessment Sonography for Trauma. Failed resuscitation with free fluid in abdomen confirmed by FAST immediately shifted to operation theatre for laparotomy and proceed. Hemodynamically stable patients underwent computerized tomography of abdomen. Organ injuries were scaled according to the American Association for the Surgery of Trauma and these patients were managed conservatively after ruling out hollow viscus perforation.Results: Majority of the patients belonged to male sex (85%) and of the age group 21-40 years constituting 58.3% of patients. Road traffic accident was the most common mode of injury which included 35 patients (66%). A total of 19 cases had splenic injury out of which 13 (68.5%) underwent non operative management and 6 (31%) underwent emergency Splenectomy. liver injury was present in 15 patients and all were managed conservatively. In total non operative management was done in 73.5% of cases and surgical management was done in 26.5% of cases.Conclusions: The presence of free fluid with organ injury always does not mandate laparotomy. Patient selection, early diagnosis and repeated clinical examination and use of appropriate investigations forms the key in non operative management of blunt trauma abdomen. RTA being the most common mode of injury, adequate measures should be taken to prevent road traffic accidents by strict action and traffic norms and citizen education.

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 The role of non-operative management (NOM) in blunt hepatic trauma

2013 ◽  
Vol 49 (3) ◽  
pp. 223-227
Author(s):  
Ayman Zaki Azzam ◽  
Abdel Hamid Gazal ◽  
Mohammed I. Kassem ◽  
Magdy A. Souror
Keyword(s):  
Operative Management ◽  
Hepatic Trauma ◽  
Non Operative Management

scholarly journals Evaluation of CE angle of Wiberg for the functional outcome in various hip pathologies: an observational study

2018 ◽  
Vol 5 (1) ◽  
pp. 182
Author(s):  
Juzer Bagwala ◽  
Susheel Soni
Keyword(s):  
Femoral Head ◽  
Observational Study ◽  
Functional Outcome ◽  
Avascular Necrosis ◽  
Femoroacetabular Impingement ◽  
Operative Management ◽  
Developmental Dysplasia ◽  
Developmental Dysplasia Of Hip ◽  
Necrosis Of Femoral Head ◽  
Non Operative Management

<p class="abstract"><strong>Background:</strong> The objective of the study was to evaluate CE Angle of Wiberg for the functional outcome in various hip pathologies.</p><p class="abstract"><strong>Methods:</strong> This is a non-randomised prospective, observational study carried out for the period of 15 months. In this study 35 hips of 28 patients with hip pathologies with age more than 5 years of both genders, hip pathologies like CAM and/or Pincer type of femoroacetabular impingement, Acetabular retroversion, Perthes like deformity, osteoarthritis hip, avascular necrosis of femoral head, developmental dysplasia of hip were studed.<strong></strong></p><p class="abstract"><strong>Results:</strong> In this prospective study out of 28 patients 9 (32.14%) were FAI, 8 (28.57%) were OA hip, 8 (28.57%) were avascular necrosis of femoral head and 3 case (10.71%) is of Perthes' disease. In FAI cases 4(44.44%) patients were of Pincer type, 5 (55.55%) were of combined type with no any case of isolated CAM form. All were unilateral involvement with average CE angle of 32.67<sup>0</sup>±11.67<sup>0</sup>. In Pincer type mean CE angle was 36.25<sup>0 </sup>±7.5<sup>0 </sup>while in Combined form the mean CE angle was 29.8<sup>0</sup>±14.4<sup>0</sup>. Out of 4 patients of Pincer FAI, 3 patients of Pincer type had CE angle between 25<sup>0</sup>-40<sup>0 </sup>which comes under normal range of CE angle, so all were planned for non operative management.</p><strong>Conclusions:</strong> We have found that all the hip pathologies reported to us had spectrum of variations in CE angle depending on the severity of disease. Variation was maximum seen in osteoarthritis and femoroacetabular impingement, in the cases of FAI maximum was of Pincer type.

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