Management of complications of first instance of hepatic trauma in a liver surgery unit: Portal vein ligation as a conservative therapeutic strategy (original) (raw)
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Liver trauma: new management trends
HPB surgery : a world journal of hepatic, pancreatic and biliary surgery, 1994
Significant trends in the treatment of hepatic trauma. Annals of Surgery; 215: 492-502. Several significant advances in the treatment of hepatic injuries have evolved over the past decade. These trends have been incorporated into the overall treatment strategy of hepatic injuries and are reflected in experiences with 411 consecutive patients. Two hundred and fifty-eight patients (63%) with minor injuries (grades I to II) were treated by simple suture or hemostatic agents with a mortality rate of 6%. One hundred and twenty-eight patients (31%) sustained complex hepatic injuries (grades III to V). One hundred seven patients (83.5%) with grades III or IV injury underwent portal triad occlusion and finger fracture of hepatic parenchyma alone.
COMPLICATIONS OF LIVER TRAUMA: A COMPREHENSIVE ANALYSIS OF IMPACT, ASSESSMENT AND CLINICAL AND SURGICAL MANAGEMENT STRATEGIES (Atena Editora), 2024
Objective: To explore the main complications associated with liver trauma, covering assessment, clinical and surgical management, and analyzing the impact of these complications on the patient's overall recovery. Method: After a careful selection of methodologies, excluding conflicts of interest and duplications, 15 articles were chosen to compose the narrative bibliographic review. The search was conducted blindly and independently. Results: The majority of patients included in the analysis were male. The main trauma mechanisms were gunshot wounds and traffic accidents. The right hepatic lobe was injured in 51.2% of cases, with hepatorrhaphy being the most frequently performed surgical correction. Additionally, patients undergoing embolization had a shorter duration of hemostatic treatments. Conclusion: The studies provided valuable information to deepen the understanding of complications arising from liver trauma, guiding more effective clinical and surgical management strategies.
World Journal of Emergency Surgery, 2015
Background: Severe liver injury in trauma patients still accounts for significant morbidity and mortality. Operative techniques in liver trauma are some of the most challenging. They include the broad and complex area, from damage control to liver resection. Material and method: This is a retrospective study of 121 trauma patients with hepatic trauma American Association for Surgery of Trauma (AAST) grade III-V who have undergone surgery. Indications for surgery include refractory hypotension not responding to resuscitation due to uncontrolled hemorrhage from liver trauma; massive hemoperitonem on Focused assessment by ultrasound for trauma (FAST) and/or Diagnostic peritoneal lavage (DPL) as well as Multislice Computed Tomography (MSCT) findings of the severe liver injury and major vascular injuries with active bleeding. Results: Non-survivors have significantly higher AAST grade of liver injury and higher Injury Severity Score (ISS) (p = 0.000; p = 0.0001). Non-survivors have significant hypotension on arrival and lower Glasgow Coma Scale (GCS) on admission (p = 0.000; p = 0.0001). Definitive hepatic repair was performed in 62(51.2 %) patient. Damage Control, liver packing and planned re-laparotomy after 48 h were used in 59(48.8 %). There was no statistically significant difference in terms of the surgical approach. There was significant difference in the amount of red blood cells (RBC) transfusion in the first 24 h between survivors and non-survivors (p = 0.001). Overall mortality rate was 33.1 %. Regarding complications non-survivors had significantly prolonged bleeding and higher rate of Acute respiratory distress syndrome (ARDS) (p = 0.0001; p = 0.0001), while survivors had significantly higher rate of pleural effusion (p = 0.0001). Conclusion: All efforts in the treatment of severe liver injuries should be directed to the rapid and effective control of bleeding, because uncontrollable hemorrhage is the cause of early death and it requires massive blood transfusion, all of which contributes to the late fatal complication.
Traumatic laceration of the portal vein
CJEM, 2015
Despite its relatively protected position, the liver is the most frequently injured solid intra-abdominal organ. 1 Most liver injuries can be managed conservatively, but about 5% to 10% require urgent laparotomy, usually when the mechanism of injury involves a vehicle accident and hemodynamic instability persists, in spite of 40 mL/kg of blood transfusion. 2 , 3 In particular, grades IV and V liver injuries may pose a challenge to the surgeon trying to control hemorrhage, the leading cause of mortality. 4 Traumatic injuries to the portal vein are rare but devastating. The mortality rate for portal vein injury ranges from 50% to 70%. A recent study of portal triad injuries has highighted the higher mortality rates associated with combination injuries involving multiple portal triad components, especially those that include portal vein injury. 5 This case study describes a unique case of relatively minor trauma in a child resulting in portal triad injury, sudden demise, and surgical r...
Non-operative management of liver trauma
Journal of the Royal Army Medical Corps, 2012
The liver is one of the commonest intra-abdominal organs injured worldwide in blunt and penetrating trauma and its management has evolved significantly in the last 30 years. Mandatory laparotomy has been replaced by an acceptance that for most blunt hepatic trauma, a selective non-operative approach is safe and effective with a failure rate ie the need to proceed to delayed laparotomy of approximately 10%. There is a markedly lower rate of complications in those that are managed non-operatively. Adjuncts to this conservative regimen such as angioembolisation and delayed laparoscopy to treat biliary peritonitis increase the chances of avoiding laparotomy. This belief in non-operative management has also been transferred to some degree to penetrating liver trauma, where there is a gradual accumulation of evidence to support this non-operative approach in a carefully selected group of patients. This article examines the evidence supporting the selective non-operative management of both...
Abdominal trauma and Liver some Management Considerations after a Retrospective Study
Albanian Journal of Trauma and Emergency Surgery
INTRODUCTION: The liver is the most frequently injured abdominal organ. Most of liver injuries are relatively minor and heal spontaneously with nonoperative management, which consists of observation and possibly arteriography and embolization. Purpose to describe the causes of trauma, the degree of injury, the chosen method of treatment, the success rate and the developed complications; comparing the results of our study with the results of literature. MATERIAL & METHODS: The study is of a retrospective character and includes all patients with abdominal trauma, presented in the Emergency Department to University Hospital of Trauma, Tirana, from May 2016 to May 2018. The study sample was taken randomly, without any study restriction. RESULTS: During the two years, 228 patients with liver trauma were reported, of whom 177 (78%) with blunt liver trauma and 51 (22%) with penetrating injuries. Men (72%) were more affected than females (28%) with a male-female ratio of 7: 3. The most comm...
Hepatic trauma treatment in a general hospital analysis of 5.5 years.pdf
During the study period, 12 (100%) patients with abdominal trauma and liver damage were treated, 10 (83%) of the male sex and two (17%) of the female sex; nine (75%) stable patients and three (25%) patients with shock status; nine (75%) cases due to open abdominal trauma and three (25%) cases due to closed trauma; eight (67%) patients with abdominal trauma and four (33%) with abdomino-thoracic trauma; seven (58%) cases caused by stab wounds, three (25%) cases due to automobile accidents, one case (8%) due to firearm and one case (8%) due to fall; two cases (16%) with admission to the packed intensive Abstract Introduction: Liver damage occurs in 20% of closed abdominal traumas but damage of the liver alone without involving other organs occurs only in 10%.