Complications of Nonoperative Management of High-Grade Blunt Hepatic Injuries

Kozar, Rosemary A.; Moore, John B.; Niles, Sarah E.; Holcomb, John B.; Moore, Ernest E.; Cothren, Clay C.; Hartwell, Elizabeth; Moore, Frederick A.

doi:10.1097/01.ta.0000188937.75879.ab

Cited by 175 publications

(110 citation statements)

References 26 publications

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“…Most of the bile leaks after blunt liver trauma are minor and recovered well after conservative treatment [12]. Major bile leak, however, can seriously hamper patient recovery and is an emerging issue in treatment for blunt liver trauma [3,4,9,13]. The key for treatment of major bile leak is timely diagnosis and effective intervention.…”

Section: Discussionmentioning

confidence: 99%

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Screening and management of major bile leak after blunt liver trauma: a retrospective single center study

Yuan

Wong

et al. 2014

Scand J Trauma Resusc Emerg Med

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BackgroundMajor bile leak after blunt liver trauma is rare but challenging. It usually requires endoscopic retrograde cholangiography (ERC) for management. However, there is still lack of specific indications. The aim of this study is to elucidate risk factors for major bile leak and indications for early ERC after blunt liver trauma.MethodsThe trauma registry of a level I trauma center in Taiwan was queried, and all blunt liver trauma patients from June, 2008 to June, 2011 were selected for retrospective review. Data collected included demographic data, laboratory data, Injury Severity Score (ISS), liver injury grade and location, management of liver trauma, length of ICU, hospital stay and treatment result. ERC was used to confirm major bile leak.Results288 blunt liver trauma patients were selected from 2,475 torso trauma patients. There were 214 (74.5%) male and 74 (25.7%) female patients. The mean ISS was 24.2. Most patients received conservative treatment. Transcatheter artery embolization (TAE) and operation were 15.6% and 10.8% respectively. Major bile leak occurred in 14 (4.9%) patients. Risk factors for bile leak include high-grade liver injury, centrally-located liver trauma and use of TAE. A bilirubin level greater than 43.6 μmol/L provides a sensitivity of 100% and specificity of 85.1% for predicting major bile leak.ConclusionsHigh injury grade; centrally-located liver trauma; and use of TAE are risk factors for major bile leak after blunt liver trauma. ERC should be arranged early if the patient has risk factors and their plasma bilirubin level is greater than 43.6μmol/L during admission.

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Section: Discussionmentioning

confidence: 99%

“…With the high success rate, various late complications (infection, bleeding, biliary complications) have become emerging challenges. They are especially common in high grade (more than grade III) liver trauma [3,4]. These late complications usually hamper patient recovery seriously.…”

Section: Introductionmentioning

confidence: 99%

Screening and management of major bile leak after blunt liver trauma: a retrospective single center study

Yuan

Wong

et al. 2014

Scand J Trauma Resusc Emerg Med

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“…Failure of non-operative management is defined as the need for surgical treatment for a patient who was offered a nonoperative alternative at the beginning of treatment. Failure of non-operative management has been associated with several factors, including transfusion of more than two units of red blood cells in the first 6 h of trauma, a positive focused abdominal sonograph of trauma (FAST), an associated spleen injury, an Injury Severity Score (ISS) over 18, and over 300 cc of free fluid in the CT scan [4][5][6].…”

Section: Introductionmentioning

confidence: 99%

Efficacy and safety of non-operative management of blunt liver trauma

Morales

Barrera

Moreno

et al. 2011

Eur J Trauma Emerg Surg

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“…After operative treatment of liver injuries, incidence of post-traumatic biliary complications such as biloma, hemobilia, and biliary fistula, ranges from 1 to 22 % [39][40][41]. The same injuries are reported at 2.8 to 7.4 % in conservatively managed liver trauma cases [41][42][43].…”

Section: Liver Lesions and Bilomasmentioning

confidence: 70%

Management of Post-Traumatic Complications by Interventional Ultrasound: a Review

2016

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Purpose of Review We reviewed the current literature to assess the feasibility of ultrasound-assisted and ultrasoundguided procedures for the treatment of post-traumatic complications and to address the indications and techniques of procedures. Recent Findings Non-operative strategies have been introduced in the treatment of severe trauma, and consequently, the incidence of some post-traumatic complications has increased. US can be useful both for the initial assessment of trauma patients and for the treatment of complications. Summary Ultrasound-guided and ultrasound-assisted procedures as a therapeutic tool in the management of post-trauma settings are probably underused, in comparison with their successful use in other acute settings. Some new possible fields of clinical researches are suggested.

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Complications of Nonoperative Management of High-Grade Blunt Hepatic Injuries

Abstract: Nonoperative management of high-grade liver injuries can be safely accomplished. Mortality is low; however, complications in grade 4 and 5 injuries should be anticipated and may require a combination of operative and nonoperative management strategies.

Cited by 175 publications

References 26 publications

Screening and management of major bile leak after blunt liver trauma: a retrospective single center study

Screening and management of major bile leak after blunt liver trauma: a retrospective single center study

Efficacy and safety of non-operative management of blunt liver trauma

Management of Post-Traumatic Complications by Interventional Ultrasound: a Review

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