Changes in the Management of Injuries to the Liver and Spleen

Richardson, J. David

doi:10.1016/j.jamcollsurg.2004.11.005

Cited by 168 publications

(156 citation statements)

References 176 publications

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“…This leads to loss of immunity to encapsulated organisms, in particular streptococcus pneumoniae, and the risk of overwhelming post-splenectomy infection (OPSI) [13] with a mortality rate of 50-70 %. [14]. Moreover splenectomy is associated with other disadvantages including an increased risk of premature death [15].…”

Section: Discussionmentioning

confidence: 99%

Proximal Versus Distal Splenic Artery Embolisation for Blunt Splenic Trauma: What is the Impact on Splenic Immune Function?

Foley

Kavnoudias

Cameron

et al. 2015

Cardiovasc Intervent Radiol

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Purpose To compare the impact of proximal or distal splenic artery embolisation versus that of splenectomy on splenic immune function as measured by IgM memory B cell levels. Materials and Methods Patients with splenic trauma who were treated by splenic artery embolisation (SAE) were enrolled. After 6 months splenic volume was assessed by CT, and IgM memory B cells in peripheral blood were measured and compared to a local normal reference population and to a post-splenectomy population. Results Of the 71 patients who underwent embolisation, 38 underwent proximal embolisation, 11 underwent distal embolisation, 22 patients were excluded, 1 had both proximal and distal embolisation, 5 did not survive and 16 did not return for evaluation. There was a significant difference between splenectomy and proximal or distal embolisation and a trend towards greater preservation of IgM memory B cell number in those with distal embolisation-a difference that could not be attributed to differences in age, grade of injury or residual splenic volume. Conclusion IgM memory B cell levels are significantly higher in those treated with SAE compared to splenectomy. Our data provide evidence that splenic embolisation should reduce immunological complications of spleen trauma and suggest that distal embolisation may maintain better function.

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Section: Discussionmentioning

confidence: 99%

Proximal Versus Distal Splenic Artery Embolisation for Blunt Splenic Trauma: What is the Impact on Splenic Immune Function?

Foley

Kavnoudias

Cameron

et al. 2015

Cardiovasc Intervent Radiol

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“…In the last 15 years, the treatment of liver trauma has progressively evolved [4,12]. At the beginning of the 1990's several articles reported the possibility of non surgical treatment in patients with hemodynamic stability similar to what is carried out by paediatric surgeons in cases of hepatosplenic injuries [9,12].…”

Section: Discussionmentioning

confidence: 99%

Blunt Trauma Liver-Conservative or Surgical Management: A Retrospective Study

Pn¹,

Ts²,

Anantharaj³

2012

J Trauma Treat

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IntroductionThe relatively fixed position of the liver and its large size makes it more prone for injury in blunt trauma of the abdomen. Liver and spleen together, account for 75% of injuries in blunt abdominal trauma. Though liver is the second most commonly injured organ in abdominal trauma; it is the most common cause of death following abdominal injury. Compared to splenic injuries, management of liver trauma still remains a challenge in the best of trauma centres [1,2].In the past, most liver injuries were treated surgically. However evidence confirms that about 86% of liver injuries have stopped bleeding by the time surgical exploration is performed and 67% of laparotomies done for blunt trauma abdomen are non-therapeutic. Imaging techniques especially Computerised Tomographic (CT) scan has created remarkable impact in managing liver trauma patients by reducing the number of laparotomies. About 80% of adults and 97% of children are presently managed conservatively worldwide at high volume trauma centres [3,4].The large size of the liver, the friable parenchyma, its thin capsule and its relatively fixed position make it prone to blunt injury. Right lobe is more often involved, owing to its larger size and proximity to the ribs [5,6]. Compression against the fixed ribs, spine or posterior abdominal wall results in predominant damage to segments 6, 7 and 8 of the liver (>85%). Pressure on right hemithorax may propagate through the diaphragm producing contusion of dome of right lobe of liver. Liver's ligamentous attachments to diaphragm and posterior abdominal wall act as sites of shearing forces during deceleration injury. Liver injury can also occur as a result of transmission of excessively high venous pressure to remote body sites at the time of impact. Weaker connective tissue framework, relatively large size and incomplete maturation and more flexible ribs account for higher chance of liver injury in children compared to adults.Deceleration injuries producing shearing forces may tear hepatic lobes and often involve the inferior vena cava and hepatic veins. A steering column injury can damage an entire lobe. Liver trauma may result in subcapsular/intrahepatic hematomas, lacerations, contusions, hepatic vascular injury and bile duct injury. Most blunt trauma livers (80% in adults and 97% in children) are treated conservatively [7,8].Conservative treatment mandates repeated clinical monitoring and surgical intervention if conservative treatment fails. A comparison of patients receiving operative and nonoperative treatment of liver Abstract Background: The liver is one of the most frequently damaged organs and remains the most common cause of death following blunt abdominal trauma. Currently, a conservative management constitutes the treatment of choice in patients with hemodynamic stability. The aim of this study is to evaluate the results of an operative and conservative management of 55 patients with liver injury treated in a single institution.

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“…Na povrede jetre treba pomisliti kod svih bolesnika sa tupom ili penetrantnom torakoabdominalnom traumom, posebno kod onih u stanju šoka sa povredama na desnoj strani tijela. Prema podacima iz literature, penetrantne povrede jetre čine 1-11%, a tupa trauma je prisutna kod 23-50% bolesnika [3,[5][6][7]. Težina povrede jetre kreće se od malih laceracija kapsule do ekstenzivnih disrupcija lobusa sa povredama jukstahepatičnih vena ili retrohepatične venae cavae inferior [8].…”

Section: Uvodunclassified

“…Težina povrede jetre kreće se od malih laceracija kapsule do ekstenzivnih disrupcija lobusa sa povredama jukstahepatičnih vena ili retrohepatične venae cavae inferior [8]. U literaturi se navodi da se mortalitet kod povreda jetre smanjivao od 66% u periodu poslije II Svjetskog rata [5,7,9] na 30-60% 1990. godine, da bi posljednjih godina iznosio 20-28%. Kod preživjelih bolesnika u 7% slučajeva se javljaju komplikacije specifične za povrede jetre.…”

Section: Uvodunclassified

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Izbor optimalne operativne procedure u liječenju povreda jetre

Krivokuća¹,

Mavija²,

Golić

et al. 2016

Biomedicinska istraž.

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Kratak sadržajUvod. Jetra je najčešće povređivan organ u traumi. Zahvaljujući unapređen-ju strategije liječenja, mortalitet kod povreda jetre je posljednjih decenija u značajnom padu. Cilj rada je da prikaže koliko su povrede jetre kompleksan problem koji zahtijeva multidisciplinarni pristup u dijagnostici i liječenju, a ciljevi hirurškog liječenja su kontrola krvarenja, očuvanje funkcije jetre i prevencija komplikacija.Metode. Retrospektivnom studijom je obuhvaćeno 98 bolesnika operisanih zbog povreda jetre na Klinici za Opštu i abdominalnu hirurgiju UKC Banja Luka u periodu 2006-2016. Iz istorije bolesti su analizirani: epidemiološki podaci, mehanizam nastanka traume, dijagnostički pristup, stepen povrede jetre, ukupna težina traume, učinjene hirurške procedure, ishod liječenja i komplikacije.Rezultati. Od 288 bolesnika koji su operisani zbog teške abdominalne traume, 98 je imalo povredu jetre (33 izolovane povrede jetre, a 55 udružene povrede jetre i nekog od abdominalnih organa). Tretman teških povreda jetre uključivao je perihepatično pakovanje kod 12, suturu jetre kod 71 i neki od tipova resekcije jetre kod 5 bolesnika. Kod 10 bolesnika učinjena je samo hirurška eksploracija i drenaža trbušne duplje. Od 74 bolesnika, kod kojih je uzrok povrede bila tupa trauma, umrlo je 19 (25,68%), dok su od 24 bolesnika sa ubodnom i sklopetarnim povredama umrla dva (8,33%) bolesnika. Mortalitet je bio značajno niži kod pacijenata s povredama I, II i III stepena u odnosu na povrede IV I V stepena (p = 0,015). Četiri (4,08%) bolesnika su imala postoperativnu sepsu, 20 (20,41%) pleuralni izliv, a kod tri (3,06%) bolesnika se razvio akutni respiratorni distress sindrom (ARDS).Zaključak. Ukupni mortalitet od 21,4% u našoj studiji je bio usko povezan sa stepenom težine povrede jetre, a značajno je smanjen zahvaljujući savremenim dijagnostičkim i terapijskim metodama.

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Changes in the Management of Injuries to the Liver and Spleen

Cited by 168 publications

References 176 publications

Proximal Versus Distal Splenic Artery Embolisation for Blunt Splenic Trauma: What is the Impact on Splenic Immune Function?

Proximal Versus Distal Splenic Artery Embolisation for Blunt Splenic Trauma: What is the Impact on Splenic Immune Function?

Blunt Trauma Liver-Conservative or Surgical Management: A Retrospective Study

Izbor optimalne operativne procedure u liječenju povreda jetre

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