Nonoperative management of blunt hepatic trauma: 80 cases

Özoğul, Bünyami; Kısaoğlu, Abdullah; Aydınlı, Bülent; Öztürk, Gürkan; Bayramoğlu, Atıf; Sarıtemur, Murat; Aköz, Ayhan; Bulut, Özgür; Atamanalp, Sabri Selçuk

doi:10.5505/tjtes.2014.20737

Cited by 7 publications

(5 citation statements)

References 18 publications

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“…Victims of blunt liver trauma are mostly from an economically active male population, in agreement with the results of national and international studies 8 , 9 .…”

Section: Discussionsupporting

confidence: 87%

Experience of non-operative management of blunt liver trauma at Hospital das Clínicas de Uberlândia: 114 cases

Fernandes

Martins

Gomes

2023

Rev. Col. Bras. Cir.

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Introduction: trauma is the leading cause of death for the age group from 1 to 49 years in Brazil. Non-Operative Management (NOM) is the gold standard in trauma centers and does not affect mortality in comparison to operative treatment. Methods: medical records were reviewed for 114 patients with blunt liver trauma treated at Hospital das Clínicas of the Federal University of Uberlândia (HC-UFU) from November 2015 to November 2020. Results: the most prevalent gender was masculine (74.5%). The most prevalent age group was 20 to 49 years (65.7%). The majority of admitted patients (60.5%) had an Injury Severity Score (ISS) of more than 15. On hospital admission, 30.7% had HR above 100 bpm and 30.70% had SBP below 100mmHg. NOM was implemented in 77.2% of patients, the failure rate was 11.36% and the specific failure rate, excluding complications of associated injuries that resulted in surgery, was 1.75%. One third of deaths were due to severe traumatic brain injury. Conclusion: the failure rate of NOM in this study is similar to the literature reports for liver trauma. The failure rate, excluding complications of associated injuries, is considered low. The recognition of the epidemiological profile of patients admitted at HC-UFU allows multidisciplinary and integrated care with specialized training, as well as the development of institutional protocols, aiming to reduce morbidity and mortality related to hepatic trauma.

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“…Victims of blunt liver trauma are mostly from an economically active male population, in agreement with the results of national and international studies 8 , 9 .…”

Section: Discussionsupporting

confidence: 87%

Experience of non-operative management of blunt liver trauma at Hospital das Clínicas de Uberlândia: 114 cases

Fernandes

Martins

Gomes

2023

Rev. Col. Bras. Cir.

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“…Within the last few decades, non-operative management for BAT has become the standard of care in many cases, especially for stable patients with injuries of the liver, spleen, or kidney [17], [18], [19], [20]. It is, therefore, necessary for emergency room teams to contain or work closely with GI or general surgeons, so that accurate assessment of abdominal injuries may be conducted, and the need for emergency laparotomy or NOM delineated [21].…”

Section: Discussionmentioning

confidence: 99%

No need for surgery? Patterns and outcomes of blunt abdominal trauma

Goedecke

Kühn

Stratos

et al. 2019

Innovative Surgical Sciences

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IntroductionThe management of a patient suffering from blunt abdominal trauma (BAT) remains a challenge for the emergency physician. Within the last few years, the standard therapy for hemodynamically stable patients with BAT has transitioned to a non-operative approach. The purpose of this study is to evaluate the outcome of patients with BAT and to determine the reasons for failure of non-operative management (NOM).Materials and methodsAnalysis of 176 consecutive patients treated for BAT was conducted in a German level 1 trauma center from 2004 to 2011. Abdominal injuries were classified according to the American Association for the Surgery of Trauma (AAST). Patients included were demonstrated to have objective abdominal trauma with either free fluid on focused assessment with sonography for trauma (FAST) or computed tomography (CT), or proven organ injury.ResultsPatients, 142 of 176 (80.7%), with BAT were initially managed non-operatively, with a success rate of 90%. The rates of NOM success were higher among those with less severe injuries; 100% with Abbreviated Injury Scale (AIS) of 1. In total, 125 patients (71.0%) were managed non-operatively, and 51 (29.0%) required surgical intervention. NOM failure occurred in 9.2% of the patients, the most common reason being initially undiagnosed intestinal perforation (46.2%). Positive correlation was identified (r = 0.512; p < 0.001) between the ISS (injury severity score) and the NACA (National Advisory Committee of Aeronautics) score. The delay in operation in NOM failure was 6 h in patients with underlying hepatic or splenic rupture and 34 h with intestinal perforation. The overall mortality of 5.1% was attributed especially to old age (p = 0.016), high severity of injury (p < 0.001), and greater need for blood transfusion (p < 0.001).ConclusionNOM was successful for the vast majority of blunt abdominal trauma patients, especially those with less severe injuries. NOM failure and operative delay were most commonly due to occult hollow viscus injury (HVI), the detection of which was achieved by close clinical observation and abdominal ultrasound in conjunction with monitoring for rising markers of infection and by multidetector computed tomography (MDCT) if additionally indicated. Based on this concept, the delay in operation in patients with NOM failure was short. This study underscores the feasibility and benefit of NOM in BAT.

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“…The liver is the most common frequently injured organ following abdominal trauma [1,2]. Motor vehicle accidents and antisocial violent behavior account for the majority of liver injuries [1].…”

Section: Introductionmentioning

confidence: 99%

Scoring system for traumatic liver injury (SSTLI) in polytraumatic patients: a predictor of mortality

Kim

Park

et al. 2014

Eur J Trauma Emerg Surg

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Nonoperative management of blunt hepatic trauma: 80 cases

Abstract: BACKGROUND: Liver is the most frequently injured organ upon abdominal trauma. We present a group of patients with blunt hepatic trauma who were managed without any invasive diagnostic tools and/or surgical intervention.

Cited by 7 publications

References 18 publications

Experience of non-operative management of blunt liver trauma at Hospital das Clínicas de Uberlândia: 114 cases

Experience of non-operative management of blunt liver trauma at Hospital das Clínicas de Uberlândia: 114 cases

No need for surgery? Patterns and outcomes of blunt abdominal trauma

Scoring system for traumatic liver injury (SSTLI) in polytraumatic patients: a predictor of mortality

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