Trauma hepático contuso: comparação entre o tratamento cirúrgico e o não operatório

Zago, Thiago Messias; Pereira, Bruno M.; Calderan, Thiago Rodrigues Araújo; Hirano, Élcio Shiyoiti; Rizoli, Sandro; Fraga, Gustavo Pereira

doi:10.1590/s0100-69912012000400011

Cited by 18 publications

(11 citation statements)

References 29 publications

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“…O fígado é o órgão mais frequentemente acometido em traumas abdominais fechados, dado sua extensão em relação aos outros órgãos abdominais (3) . Tradicionalmente, pacientes hemodinâmicamente estáveis, sem indicações óbvias de intervenção cirúrgica e com lesão hepática de baixo grau (I a III), eram tratados clinicamente com observação na unidade de terapia intensiva e, se necessário, arteriografia diagnóstica com ou sem embolização.…”

Section: Discussionunclassified

“…Dentre as complicações tardias do tratamento conservador, podem ser incluídos abscessos, insuficiência hepática, fístulas biliares, abscessos e biliomas, sendo estes últimos abordáveis por radiologia intervencionista (drenagem percutânea) (2,7) . O óbito pode ocorrer em 1,5% dos casos, como descrito por Zago et al (3) .…”

Section: Discussionunclassified

“…O fígado e o baço são os órgãos mais acometidos, estando a lesão hepática presente em até 16% dos politraumatizados (1) . Com o advento da tomografia computadorizada, o exame de imagem do abdome substituiu o lavado peritoneal na avaliação do trauma, por sua maior especificidade, permitindo a categorização da lesão avaliando sua extensão e gravidade, bem como o diagnostico de lesões associadas, levando a indicações cirúrgicas mais precisas, evitando-se abordagens desnecessárias (2)(3) . A American Association of Surgery of Trauma (AAST) classifica o trauma hepático em relação às dimensões do hematoma e da laceração do parênquima graduados de I a VI (4) (Tabela 1).…”

Section: Introductionunclassified

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Procedimento Endovascular Como Tratamento Não Cirúrgico Em Trauma Hepático Grau V: Um Relato De Caso

Coimbra

Sampaio

Silva

et al. 2016

ACS

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Conflito de interesses: Não AbstractIntroduction: Liver injuries occur in 16% of all poly-trauma patients. The American Association of Surgery of Trauma uses computer tomography findings to classify them into grades I through VI. Grade I, II and III lesions have better prognosis, and may be successfully treated with conservative clinical approaches. Grade IV through VI typically require surgical intervention. The present article presents the efficacy of endovascular treatment of Grade V liver injury in the medium and long terms, describing the clinical stabilization in acute phases and maintenance of hepatic function during a 6-month follow-up. Case Report: A 26-year-old male victim of blunt abdominal trauma and grade V liver injury had a successful hemodynamical stabilization after being subjected to arteriographic selective embolization. A surgical approach was necessary later on to remove intraabdominal clots, with adequate post-surgical evolution. The patient kept under follow up at the outpatient clinic for six months after the traumatic event, with full recovery of liver function and enzymes. Conclusion: Non-surgical treatment of grade V hepatic lesion may be used in selected cases in centers with hemodynamic and intensive care units.

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Section: Discussionunclassified

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Procedimento Endovascular Como Tratamento Não Cirúrgico Em Trauma Hepático Grau V: Um Relato De Caso

Coimbra

Sampaio

Silva

et al. 2016

ACS

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“…With technological advances in imaging and greater accessibility to computed tomography and FAST (Focused Assessment with Sonography for Trauma), conservative treatment has become possible for patients with hemodynamically stable hepatic trauma 15,18 , which contributed to reduce unnecessary laparotomy 7,12,[18][19][20][21] . Thus, there is a tendency to avoid routine laparotomy, especially for patients with hepatic trauma who are hemodynamically stable and displsy signs of peritonitis 19 .…”

Section: Injured Regionmentioning

confidence: 99%

Epidemiological evaluation of hepatic trauma victims undergoing surgery

Kalil

Amaral

2016

Rev. Col. Bras. Cir.

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“…Zago et al [22], em um estudo com 265 pacientes, evidenciaram que cerca de 35% dos traumas hepáticos estavam relacionados a acidentes com automóveis, enquanto as motocicletas estavam envolvidas em cerca de 25% [22]. Os mesmos autores, em outro estudo, com 748 pacientes, demonstraram que dentro dos traumas hepáticos fechados, 44,6% foram relacionados com carros e 15% com motocicletas [2].…”

Section: /6unclassified

Trauma hepático: prevalência e características epidemiológicas de vítimas encaminhadas ao Instituto Médico Legal de Palmas, Tocantins

Castro

Ferreira

Pereira

et al. 2015

Sci Med

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RESUMO ABSTRACTAims: To assess the prevalence and epidemiological characteristics of hepatic trauma in victims referred to the Forensic Department of Palmas, State of Tocantins, Brazil. Methods: A retrospective cross-sectional study was performed with all the victims referred to the Forensic Department of Palmas from January 2006 to December 2010, to investigate violent deaths with severe damage to the liver tissue. The data were collected from the Forensic Department records. The following data were evaluated: sex, age, mechanism of injury (in case of motor vehicle accidents, the type of vehicle involved), types of trauma associated with abdominal trauma, presence of abdominal lesions associated with hepatic injury, the American Association for the Surgery of Trauma Organ Injury Scale, and number of deaths caused directly by hepatic trauma. The statistical analysis included absolute and relative frequencies of the variables. Results: A total of 241 (13.4%) out of 1,796 victims had liver trauma, among whom 85.5% were male and 42.9% belonged to the 21-30 year age group. Motor vehicle accidents were the major cause of trauma in 143 cases, (59.3%), involving mainly motorcycles (53 cases or 37%). Blunt trauma was the most frequent mechanism of injury, having occurred in 179 cases (74.3%). The right lobe was injured in 98 cases (40.7%). A total of 147 victims (61%) had polytrauma. Splenic injury, present in 65 (27%) of the cases, was mostly associated with liver trauma. Liver injury of grade II was detected in 102 cases (42.4%) and was therefore the most prevalent type of damage. Twenty-one (8.7%) deaths were directly related to liver trauma. Conclusions: Blunt injury, caused mainly by motor vehicle accidents (especially with motorcycles), was the most common type of liver trauma observed in violent deaths, according to the records of the Forensic Department of Palmas. Young men of working age were the most frequent victims with liver trauma.KEY WORDS: liver; wounds and injuries; traumatology; epidemiology; accidents, traffic. Scientia Medica Artigo originAlOpen Access 2015;25(1):ID19737 ISSN 1980ISSN -6108 : http://dx.doi.org/10.15448/1980ISSN -6108.2015 Recebido: janeiro,

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Trauma hepático contuso: comparação entre o tratamento cirúrgico e o não operatório

Abstract: A non-operative approach resulted in lower complications, a lower need for blood transfusions and lower mortality.

Cited by 18 publications

References 29 publications

Procedimento Endovascular Como Tratamento Não Cirúrgico Em Trauma Hepático Grau V: Um Relato De Caso

Procedimento Endovascular Como Tratamento Não Cirúrgico Em Trauma Hepático Grau V: Um Relato De Caso

Epidemiological evaluation of hepatic trauma victims undergoing surgery

Trauma hepático: prevalência e características epidemiológicas de vítimas encaminhadas ao Instituto Médico Legal de Palmas, Tocantins

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