Non-operative management of blunt hepatic trauma

Carrillo, Eddy H.; Platz, Andreas; Miller, Frank B.; Richardson, J. David; Polk, Hiram C.

doi:10.1046/j.1365-2168.1998.00721.x

Cited by 161 publications

(128 citation statements)

References 57 publications

Supporting

Mentioning

112

Contrasting

Unclassified

Order By: Relevance

“…The two main variables guiding the therapeutic approach were hemodynamic instability and the need for transfusion [19][20][21]. In our centre conservative treatment was implemented in almost 50% of the cases in the last 5 years with a failure rate of 21%, which is slightly higher than what has been reported in the literature [6].…”

Section: Discussioncontrasting

confidence: 45%

“…In the series published recently, the applicability of conservative treatment in patients with liver injury has varied from 35% to 82% [6,16] according to the year, the selection criteria and the number of patients studied. The two main variables guiding the therapeutic approach were hemodynamic instability and the need for transfusion [19][20][21].…”

Section: Discussionmentioning

confidence: 99%

“…However, in the remaining 10%-20% of the severe hepatic injuries the decision as to whether surgery is necessary represents a difficult challenge for the surgeon. Therapeutic evolution has become possible thanks to the diffusion of imaging techniques such as echocardiography and abdominal CT which are more rapid, sensitive and specific in the diagnosis of abdominal injuries [2,12,14,17,18], and they have replaced peritoneal lavage because of its low specificity and bad prediction of the need for laparotomy [17], despite its high sensitivity and speed of application. In our case series, if the patient presents signs of hemodynamic instability, the patient was subjected for abdominal CT with endovenous contrast to provide better knowledge of the liver injury, HIS classification and the determination or discarding of associated intra abdominal injuries.…”

Section: Discussionmentioning

confidence: 99%

“…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%).…”

Section: Introductionmentioning

confidence: 99%

See 3 more Smart Citations

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

Pn¹,

Ts²,

Anantharaj³

2012

J Trauma Treat

View full text Add to dashboard Cite

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.

show abstract

Section: Discussioncontrasting

confidence: 45%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

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

Pn¹,

Ts²,

Anantharaj³

2012

J Trauma Treat

View full text Add to dashboard Cite

show abstract

“…Segundo classificação AAST-OIS, as lesões mais leves correspondem àquelas até grau III; em média, 85% dos traumas hepáticos se enquadram dentro desta realidade [3,26,27]. O estudo em questão evidenciou que aproximadamente 90% das lesões, tanto contusas quanto penetrantes, apresentavam até grau III.…”

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

View full text Add to dashboard Cite

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,

show abstract