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 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.

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 Pedicled omentum hepatorrhaphy in blunt hepatic trauma

2017 ◽  
Vol 4 (9) ◽  
pp. 3038 ◽  
Author(s):  
Bhavinder K. Arora ◽  
Rachit Arora ◽  
Akshit Arora
Keyword(s):  
Liver Injury ◽  
Motor Vehicle ◽  
Damage Control ◽  
Damage Control Surgery ◽  
Male Dominance ◽  
Active Bleeding ◽  
Haemodynamic Instability ◽  
Hepatic Trauma ◽  
Artery Ligation ◽  
Pedicled Omentoplasty

Background: The liver is the most common solid viscera injured in motor vehicle accidents. Advances in radiological diagnostic techniques and critical care have increasing trend towards the nonoperative management. Still operative management is needed if there is continuous bleed or haemodynamic instability. The omentum commonly known as policeman of abdomen as it reaches intra-abdominal injury site. It is known to adhere to the site of injury and seals it. It increases the vascularity and starts neoangiogenesis. This produces haemostasis and promotes wound healing.Methods: In this study 24 patients were managed by this technique of pedicled omentoplasty. These patients were in the age group of 22 to 42 years. There was male dominance, 22 patients were males (91.7%) while only 2 patients were females (8.3%). The use of omentum in packing is described here. The omentum is converted to a pedicled flap based on right omental artery by tailoring it. The active bleeding vessels can be ligated. The whole length of pedicled omentum is packed in liver cavity. Using liver sutures two or more sutures are applied for stabilization.Results: On exploration, the hepatic injury was assigned grade as per AAST liver injury scale. Out of 24 patients included in this study; two (8.33%) were grade I patients, three (12.5%) were grade II patients, nine (37.5%) were grade III patients and ten (41.67%) were grade IV patients. Patients with grade V and grade VI were dealt by perihepatic packing as damage control surgery were excluded from this study.Conclusions: Pedicled omentoplasty in blunt hepatic trauma can be used irrespective of the grade of liver injury. It should be used in combination with other procedures like debridement, segmental or unsegmental resection, control of active bleeding vessels, use of Pringles manoeuvre, selective hepatic artery ligation and even with deep mattress suturing. This helps in haemostasis, early healing and rapid recovery with minimum complications. 

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 Immune-Mediated Drug-Induced Liver Injury: Immunogenetics and Experimental Models

2021 ◽  
Vol 22 (9) ◽  
pp. 4557
Author(s):  
Alessio Gerussi ◽  
Ambra Natalini ◽  
Fabrizio Antonangeli ◽  
Clara Mancuso ◽  
Elisa Agostinetto ◽  
...  
Keyword(s):  
Liver Injury ◽  
Experimental Models ◽  
Clinical Event ◽  
Drug Induced ◽  
Drug Induced Liver Injury ◽  
Immune Mediated ◽  
Liver Injuries ◽  
Immunological Mechanisms ◽  
Molecular Aspects ◽  
Therapeutic Tools

Drug-induced liver injury (DILI) is a challenging clinical event in medicine, particularly because of its ability to present with a variety of phenotypes including that of autoimmune hepatitis or other immune mediated liver injuries. Limited diagnostic and therapeutic tools are available, mostly because its pathogenesis has remained poorly understood for decades. The recent scientific and technological advancements in genomics and immunology are paving the way for a better understanding of the molecular aspects of DILI. This review provides an updated overview of the genetic predisposition and immunological mechanisms behind the pathogenesis of DILI and presents the state-of-the-art experimental models to study DILI at the pre-clinical level.

scholarly journals Liver Injury and the Macrophage Issue: Molecular and Mechanistic Facts and Their Clinical Relevance

2021 ◽  
Vol 22 (14) ◽  
pp. 7249
Author(s):  
Siyer Roohani ◽  
Frank Tacke
Keyword(s):  
Bone Marrow ◽  
Liver Injury ◽  
Current Knowledge ◽  
Hepatocellular Cancer ◽  
Complete Recovery ◽  
Hepatic Macrophages ◽  
Liver Injuries ◽  
Microbial Products ◽  
Injured Liver

The liver is an essential immunological organ due to its gatekeeper position to bypassing antigens from the intestinal blood flow and microbial products from the intestinal commensals. The tissue-resident liver macrophages, termed Kupffer cells, represent key phagocytes that closely interact with local parenchymal, interstitial and other immunological cells in the liver to maintain homeostasis and tolerance against harmless antigens. Upon liver injury, the pool of hepatic macrophages expands dramatically by infiltrating bone marrow-/monocyte-derived macrophages. The interplay of the injured microenvironment and altered macrophage pool skews the subsequent course of liver injuries. It may range from complete recovery to chronic inflammation, fibrosis, cirrhosis and eventually hepatocellular cancer. This review summarizes current knowledge on the classification and role of hepatic macrophages in the healthy and injured liver.

scholarly journals Acute Kidney Injury Recognition and Management: A Review of the Literature and Current Evidence

2015 ◽  
Vol 8 (5) ◽  
pp. 120 ◽  
Author(s):  
Syed Raza Shah ◽  
Sameer Altaf Tunio ◽  
Mohammad Hussham Arshad ◽  
Zorays Moazzam ◽  
Komal Noorani ◽  
...  
Keyword(s):  
Acute Kidney Injury ◽  
Damage Control ◽  
Kidney Injury ◽  
Control Measures ◽  
Current Evidence ◽  
Disease Treatment ◽  
Complex Disorder ◽  
Electrolyte Homeostasis ◽  
Life Threatening ◽  
Life Threatening Event

<p>Acute renal failure is defined as a rapid decrease in the glomerular filtration rate, occurring over a period of hours to days and by the inability of the kidney to regulate fluid and electrolyte homeostasis appropriately. AKI is a catastrophic, life-threatening event in critically ill patients. AKI can be divided into pre-renal injury, intrinsic kidney disease (including vascular insults) and obstructive uropathies. The prognosis of AKI is highly dependent on the underlying cause of the injury. Children who have AKI as a component of multisystem failure have a much higher mortality rate than children with intrinsic renal disease. Treatment of AKI is subjected to risk stratification and ongoing damage control measures, such as patients with sepsis, exposure to nephrotoxic agents, ischemia, bloody diarrhea, or volume loss, could be helped by optimizing the fluid administrations, antibiotics possessing least nephrotoxic potential, blood transfusion where hemoglobin is dangerously low, limiting the use of nephrotoxic agents including radio contrast use, while maximize the nutrition. Acute kidney injury remains a complex disorder with an apparent differentiation in pathology between septic and nonseptic forms of the disease. Although more studies are still required, progress in this area has been steady over the last decade with purposeful international collaboration.</p>

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