scholarly journals Traumatic Intraparenchymal Pseudoaneurysm on Initial Imaging Predicts Injury Progression in Patients with Nonoperative Major Blunt Liver Injury

2017 ◽  
Author(s):  
Duraid Younan ◽  
T. Mark Beasley ◽  
Andrew Papoy ◽  
Geoffrey Douglas ◽  
Patrick Bosarge
Keyword(s):  
Liver Injury ◽  
Ct Scan ◽  
Management Plan ◽  
Liver Trauma ◽  
Imaging Data ◽  
Blunt Liver Injury ◽  
Negative Results ◽  
Liver Injuries ◽  
Injury Progression ◽  
Repeat Imaging

Abstract Objective: Identify factors that would predict which patients would benefit from repeat imaging after major blunt liver injury. Summary of Background Data: Most patients who present with hemodynamic stability and no evidence of peritonitis after blunt liver injury are successfully managed nonoperatively. Little information is available regarding the utility of reimaging major blunt liver injuries for patients who are managed nonoperatively. Methods: A retrospective review of patients admitted to a level I trauma center with major blunt liver injuries (AAST grades 3-5) was conducted. Inclusion criteria were those admitted from July 2012 to June 2014 with blunt liver trauma who survived the first 24 hours and underwent repeat imaging. Data included demographics, procedures performed and computerized tomography (CT) scan findings. Findings on the second CT scan were categorized as Unchanged, Worse, Improved, or Negative. Results: 128 patients had blunt major liver injuries; 66 patients underwent repeat imaging. The mean time to repeat CT was 1.95 days. On repeat CT 47 were "Unchanged", 3 "Worse", 14 "Improved" and 2 "Negative". Three patients underwent angiography. One required embolization of a pseudoaneurysm. In 63 patients (95%), the second CT did not change the management plan. The presence of a pseudoaneurysm was significantly related to a worsening of the second CT (p=0.0475). Patients with admission hematocrit (Hct) below 32% were more likely to have a worsened second CT (p=0.0370). Conclusions: A pseudoaneurysm on admission CT and Hct <32% predict major liver injury progression suggesting that routine reimaging is warranted in this group.

scholarly journals Liver Trauma in the Kitchen: Preparing Whipped Cream with a Siphon Is Not without Risk

2015 ◽  
Vol 2015 ◽  
pp. 1-3
Author(s):  
Jeremy Bourenne ◽  
Béatrice Eon ◽  
Fouad Bouzana ◽  
Dominique Lambert ◽  
Estelle Jean ◽  
...  
Keyword(s):  
Liver Injury ◽  
Ct Scan ◽  
Hepatic Artery ◽  
Liver Trauma ◽  
Severe Liver ◽  
Abdominal Ct ◽  
Severity Of Injury ◽  
Abdominal Ct Scan ◽  
Capsular Rupture ◽  
Whipped Cream

We report the case of a 36-year-old woman suffering from liver injury caused by the malfunction of a whipped cream siphon. When this patient handled the whipped cream siphon, the screwed metallic upper part of the siphon was suddenly dissociated from its base and came violently striking her right hypochondrium. At first, the severity of injury was underestimated. Subsequently, due to the persistence of pain experienced by the patient, an abdominal CT scan was performed. It highlighted a severe liver injury with rupture of a branch of the hepatic artery. The evolution was favorable after completion of an embolization and a secondary capsular rupture.

scholarly journals New hemostatic device for grade IV–V liver injury in porcine model: a proof of concept

2019 ◽  
Vol 14 (1) ◽  
Author(s):  
Juan José Segura-Sampedro ◽  
Cristina Pineño-Flores ◽  
Andrea Craus-Miguel ◽  
Rafael Morales-Soriano ◽  
Francesc Xavier González-Argente
Keyword(s):  
Liver Injury ◽  
Porcine Model ◽  
Hypovolemic Shock ◽  
Liver Trauma ◽  
Severe Liver ◽  
New Device ◽  
Liver Injuries ◽  
Classic Technique ◽  
Negative Side Effects ◽  
The One

Abstract Background The liver is the most injured organ following abdominal trauma. Uncontrolled bleeding remains the main cause of early liver injury-related death, with a mortality rate of 50–54% in the first 24 h after admission and with 80% of operative deaths. Packing and reoperation account for the increased survival in severe liver trauma, and they are recommended for severe liver injuries (grades IV–V). Perihepatic packing can lead to several potential complications. An excessive packing can cause complications due to abdominal compartment syndrome, while a soft packing may be ineffective, and thus, bleeding can continue inadvertently with the consequent hypovolemic shock and potentially death. Methods We designed a new vacuum-based device to perform perihepatic packing without the negative side-effects of the classic technique. We conducted a prospective pilot feasibility study in a porcine model. We compared the traditional perihepatic packing (PHP) (n = 2) with the new VacBagPack device (VBP) (n = 2). Results Both pigs survived with the new device and showed an equivalent outcome to the one that survived in the traditional technique group. Blood tests were similar too. This suggests that VBP could be at least as effective as traditional PHP. Conclusions We establish a first step towards the development of a new packing device. A new study with a bigger sample size still in pigs will be conducted. Also, an industrial model of the device is currently in production.

Injuries Associated with Pediatric Liver Trauma

2007 ◽  
Vol 73 (1) ◽  
pp. 37-41 ◽  
Author(s):  
John A. Deluca ◽  
Damian R. Maxwell ◽  
Sarah K. Flaherty ◽  
Jason M. Prigozen ◽  
Mary E. Scragg ◽  
...  
Keyword(s):  
Liver Injury ◽  
Injury Severity ◽  
Liver Trauma ◽  
Childhood Mortality ◽  
Associated Injuries ◽  
Injury Management ◽  
Pediatric Liver ◽  
Liver Injuries ◽  
Average Patient ◽  
High Index Of Suspicion

Injury remains the leading cause of childhood mortality for children younger than 14 years of age, with the liver being particularly susceptible to blunt trauma in children. This study reviews the authors’ institutions’ experience with pediatric liver injuries in an attempt to establish current patterns of injury, management and outcomes. A single-center, retrospective review was conducted of 105 consecutive pediatric patients who presented with a traumatic liver injury from January 1996 through February 2004. Average patient age was 13.1 ± 4.9 years and 58 per cent were male. Perihospital mortality was 8.6 per cent, with 67 per cent of mortality being attributed to head injury. The majority of patients were managed nonoperatively (81%). Liver injury was most often grade II (35%) by CT scan. Liver injury grade did not affect survival, but did affect injury management, with grade I and grade IV liver injuries more likely to be managed surgically ( P < 0.001). Grade I liver injuries were associated with concomitant spleen injuries, whereas grade IV injuries were associated with pancreatic injuries. Surgical management was associated with a higher injury severity score ( P = 0.005), higher mortality ( P = 0.01), and with other associated injuries as well. Children experiencing blunt abdominal trauma are at risk of significant morbidity and mortality; however, these risks stem more likely from associated injuries than injury to the liver proper. Clinicians should maintain a high index of suspicion for potentially catastrophic associated injuries to the pancreas with high-grade liver injury.

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.

scholarly journals Start of Polytrauma Management in University Hospital: First Experience with Liver Trauma

2014 ◽  
Vol 14 (1) ◽  
pp. 20-25
Author(s):  
Solvita Stabina ◽  
Aleksejs Kaminskis ◽  
Guntars Pupelis
Keyword(s):  
Liver Injury ◽  
Cause Of Death ◽  
Nonoperative Management ◽  
Skull Fracture ◽  
Flail Chest ◽  
Young Patients ◽  
Liver Trauma ◽  
University Hospital ◽  
Traumatic Rupture ◽  
Liver Injuries

Summary Introduction. Trauma is a leading cause of death, particularly among young patients. Spleen is the most commonly damaged organ in blunt abdominal trauma and liver injury is the main cause of death. Aim of the study. Review of the literature and recent clinical experience in the management of blunt liver injuries in the Riga East clinical university hospital. Materials and methods. Three-year experience in the management of liver traumatic rupture was retrospectively and prospectively analysed. The study included 64 patients over 15 years of age with blunt hepatic injuries. Exclusion criteria were patients with life-incompatible haemorrhagic shock. The Statistical analysis of the data was performed by median and mean of the Microsoft Excel 2010 and SPSS 22 version. Results. A total of 64 patients were treated in our institution during the period from November 2010 till November 2013. Isolated liver injuries were diagnosed in 49 cases, combined liver and spleen injuries in 15 cases. Most commonly mechanism ofinjury were road traffic accidents, falls and low energy blunt traumas (criminal beaten, sports injuries);19 patients underwent laparotomy for haemostasis while nonoperative management was used in 45 patients. Haemodynamic stability of the patient and CT confirmed liver injury were the main criteria for nonoperative management. One patient died atthe time of laparotomy from injuries not compatible with life – severe head injury with basal skull fracture, aortic arc rupture, flail chest and liver and spleen injury. Conclusions. Conservative management of liver trauma is justified in haemodynamically(HD) stable patients after thorough risk assessment and computed tomography (CT) based injury grading in centres with sufficient expertise and medical resources.

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.

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.

COVID-19: how nuclear medicine can provide a differential diagnosis in very dubious case

Coronaviruses ◽  
2020 ◽  
Vol 01 ◽  
Author(s):  
Maria Silvia De Feo ◽  
Viviana Frantellizzi ◽  
Giuseppe De Vincentis
Keyword(s):  
Infectious Disease ◽  
Differential Diagnosis ◽  
Ct Scan ◽  
Imaging Technique ◽  
False Negative ◽  
Clinical Signs ◽  
Negative Results ◽  
Infectious Disease Department ◽  
False Negative Results ◽  
99Mtc Hmpao

Background: We present the case of a 55-year-old woman, admitted to the Infectious Disease Department of Policlinico Umberto I, Rome, in mid-March 2020, with suspicion of COVID-19 infection. Objective: The rRT-PCR was negative and the following CT scan, performed to exclude false-negative results and help diagnosis, was inconclusive. Methods: It was decided to submit the patient to 99mTc-HMPAO-labelled leukocyte scan. Results: This exam led to the diagnosis of infective endocarditis. Conclusion: In the present pandemic scenario, 99mTc-HMPAO-labelled leukocyte scan represents a reliable imaging technique for differential diagnosis with COVID-19 in patients with confusing clinical signs, possible false-negative rRT-PCR results and inconclusive CT scan.

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.

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