495 ANGIOGRAPHIC EMBOLIZATION AS AN ADJUNCNTIVE TREATMENT FOR THE NON-OPERATIVE MANAGEMENT OF PENETRATING LIVER INJURIES

2005 ◽  
Vol 53 (1) ◽  
pp. S164.6-S165
Author(s):  
F. Banimahd ◽  
S. Huerta ◽  
M. Lekawa ◽  
M. O. Dolich
Keyword(s):  
Operative Management ◽  
Angiographic Embolization ◽  
Liver Injuries ◽  
Non Operative Management

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.

Non-operative management of blunt liver injuries

1991 ◽  
Vol 78 (8) ◽  
pp. 968-972 ◽  
Author(s):  
M. J. Hollands ◽  
J. M. Little
Keyword(s):  
Operative Management ◽  
Liver Injuries ◽  
Non Operative Management

Long-Term Follow-Up After Non-operative Management of Blunt Splenic and Liver Injuries: A Questionnaire-Based Survey

2017 ◽  
Vol 42 (5) ◽  
pp. 1358-1363 ◽  
Author(s):  
Peter Moreno ◽  
Matthias Von Allmen ◽  
Tobias Haltmeier ◽  
Daniel Candinas ◽  
Beat Schnüriger
Keyword(s):  
Operative Management ◽  
Liver Injuries ◽  
Long Term Follow Up ◽  
Non Operative Management

scholarly journals Selective non-operative management of penetrating liver injuries at a UK tertiary referral centre

2014 ◽  
Vol 96 (6) ◽  
pp. 423-426 ◽  
Author(s):  
P MacGoey ◽  
A Navarro ◽  
IJ Beckingham ◽  
IC Cameron ◽  
AJ Brooks
Keyword(s):  
Phase Contrast ◽  
Injury Severity ◽  
Penetrating Trauma ◽  
Operative Management ◽  
Arterial Phase ◽  
Haemodynamic Instability ◽  
Tertiary Referral Centre ◽  
Contrast Extravasation ◽  
Liver Injuries ◽  
Non Operative Management

Introduction Selective non-operative management (SNOM) of penetrating abdominal injuries has increasingly been applied in North America in the last decade. However, there is less acceptance of SNOM among UK surgeons and there are limited data on UK practice. We aimed to review our management of penetrating liver injuries and, specifically, the application of SNOM. Methods A retrospective review was performed of patients presenting with penetrating liver injuries between June 2005 and November 2013. Results Thirty-one patients sustained liver injuries due to penetrating trauma. The vast majority (97%) were due to stab wounds. The median injury severity score was 14 and a quarter of patients had concomitant thoracic injuries. Twelve patients (39%) underwent immediate surgery owing to haemodynamic instability, evisceration, retained weapon or diffuse peritonism. Nineteen patients were stable to undergo computed tomography (CT), ten of whom were selected subsequently for SNOM. SNOM was successful in eight cases. Both patients who failed SNOM had arterial phase contrast extravasation evident on their initial CT. Angioembolisation was not employed in either case. All major complications and the only death occurred in the operatively managed group. No significant complications of SNOM were identified and there were no transfusions in the non-operated group. Those undergoing operative management had longer lengths of stay than those undergoing SNOM (median stay 6.5 vs 3.0 days, p<0.05). Conclusions SNOM is a safe strategy for patients with penetrating liver injuries in a UK setting. Patient selection is critical and CT is a vital triage tool. Arterial phase contrast extravasation may predict failure of SNOM and adjunctive angioembolisation should be considered for this group.

Liver injuries in children: The role of selective non-operative management

Injury ◽  
2006 ◽  
Vol 37 (1) ◽  
pp. 66-71 ◽  
Author(s):  
A. Landau ◽  
A.B. van As ◽  
A. Numanoglu ◽  
A.J.W. Millar ◽  
H. Rode
Keyword(s):  
Operative Management ◽  
Liver Injuries ◽  
Non Operative Management

scholarly journals Predictors of failure in non-operative management of blunt liver trauma

2017 ◽  
Vol 4 (9) ◽  
pp. 2913 ◽  
Author(s):  
Andika A. Winata ◽  
Reno Rudiman
Keyword(s):  
Demographic Data ◽  
Fluid Collection ◽  
Transaminase Level ◽  
Operative Management ◽  
Nonoperative Treatment ◽  
Liver Trauma ◽  
Group I ◽  
Liver Injuries ◽  
Non Operative Management ◽  
Blunt Liver Trauma

Background: Liver is the most injured organ in abdominal trauma. Nonoperative treatment (NOM) is increasingly being adopted as the initial management strategy. The aim of this study was to evaluate the results of operative and conservative management of patients with blunt liver injury treated in a single institution.Methods: A retrospective study, analyzing patients admitted from 2011-2015 with the diagnosis of liver trauma, was performed. The patients were classified according to the intention to treatment: Group I, NOM; Group II, operative management and Group III, fail in NOM management. We analyzed demographic data, injury classification, associated injuries, transfusions, shock, liver function test, lactate level, and mortality rates.Results: Over the five years period, 68 patients were recorded, 45 were successful (S-NOM) and 18 were failed (F-NOM). No differences in age, sex or initial hemodynamics were found between S-NOM and F-NOM. The F-NOM patients were more seriously injured, more acidotic, required transfusion, had more fluid collection at FAST, had worse transaminase level and higher mortality rate. Grade of liver injuries was the independent risk factor of failure in nonoperating management of blunt liver trauma with the cut-off point is 3.66.Conclusions: Non-operative management of blunt liver injuries is successful in some cases. Patients with more severe injury tend to have an operation. High-grade blunt liver injuries always present with a worse condition and require an operation.

scholarly journals Improved outcomes in the non-operative management of liver injuries

HPB ◽  
2011 ◽  
Vol 13 (5) ◽  
pp. 350-355 ◽  
Author(s):  
Teun Peter Saltzherr ◽  
Cees H. van der Vlies ◽  
Krijn P. van Lienden ◽  
Ludo F.M. Beenen ◽  
Kees Jan Ponsen ◽  
...  
Keyword(s):  
Operative Management ◽  
Improved Outcomes ◽  
Liver Injuries ◽  
Non Operative Management

Non-operative management of penetrating liver injuries: A prospective study

1986 ◽  
Vol 73 (9) ◽  
pp. 736-737 ◽  
Author(s):  
D. Demetriades ◽  
B. Rabinowitz ◽  
C. Sofianos
Keyword(s):  
Prospective Study ◽  
Operative Management ◽  
Liver Injuries ◽  
A Prospective Study ◽  
Non Operative Management

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 Study of blunt trauma abdomen involving liver injuries based on grade of injury, management: a single centre study

2019 ◽  
Vol 6 (3) ◽  
pp. 793 ◽  
Author(s):  
Vinod Kumar Jyothiprakasan ◽  
Chinthakindhi Madhusudhan ◽  
Challa Sravya Reddy
Keyword(s):  
Operative Management ◽  
Liver Trauma ◽  
Single Centre ◽  
Initial Management ◽  
Mortality And Morbidity ◽  
Injury Management ◽  
Operative Repair ◽  
Liver Injuries ◽  
Single Centre Study ◽  
Non Operative Management

Background: Modern treatment of liver trauma is increasingly non-operative. Advantages of non-operative management include avoidance of non-therapeutic celiotomies and the associated cost and morbidity, fewer intra-abdominal complications compared to operative repair and reduced transfusion risks. It is associated with a low overall morbidity and mortality and does not result in increase in length of the hospital stay. The objectives was to study efficacy of non-operative management of blunt liver injury.Methods: Seventy patients were studied, out of which 59 were initially given a trial of non-operative management and 11 patients were immediately shifted to the operating room. Of the 59 patients initially considered for non-operative management, 5 of them became unstable hemodynamically and were operated. Any complications arising in patients in non-operative group were managed with the help of interventional radiological procedures.Results: Total 54 patients were managed successfully without operative intervention which included patients with higher grade of injuries. 11 patients were shifted to surgery on arrival as they did not respond to resuscitation measures. Mortality and morbidity were found to be higher in patients undergoing surgery. Also, number of transfusions required, ICU stay and total number of days in hospital were higher in operated group. High ISS, low BP at admission, higher grade of injury in this study were seen in patients who failed non-operative management.Conclusions: Non-operative management is the initial management of choice in hemodynamically stable patients, irrespective of the grade of injury and is associated with less mortality and morbidity.

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