Operative Management and Outcomes in 103 AAST-OIS Grades IV and V Complex Hepatic Injuries: Trauma Surgeons Still Need to Operate, but Angioembolization Helps

Asensio, Juan A.; Roldán, Gustavo; Petrone, Patrizio; Rojo, Esther García; Tillou, Areti; Kuncir, Eric; Δημητριάδης, Δημήτριος; Velmahos, George C.; Murray, James A.; Shoemaker, William C.; Berne, Thomas V.; Chan, Linda S.

doi:10.1097/01.ta.0000054647.59217.bb

Cited by 166 publications

(94 citation statements)

References 32 publications

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“…[13][14][15] In several studies, 70-80% non-operative management rates have beenreported for intraabdominal solid organ injuries. [14][15][16] Similarly, 71.4% of spleen injuries, 79.4% of liver injuries, and 88% of renal injuries were managed non-operatively in the present study.…”

Section: Discussionmentioning

confidence: 93%

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Multivariate analysis of patients with blunt trauma and possible factors affecting mortality

Özpek

Yücel

Atak

et al. 2015

Ulus Travma Acil Cerrahi Derg

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Section: Discussionmentioning

confidence: 93%

“…In different studies with high grade liver injuries and unstable pelvis fractures, 40-70% mortality rates have been reported after packing and angioembolisation. [7,[16][17][18] In our study, a total of nine patients (75%) died including five out of 7 patients with hepatic packing and four out of 5 patients with pelvic packing.…”

Section: Discussionmentioning

confidence: 99%

Multivariate analysis of patients with blunt trauma and possible factors affecting mortality

Özpek

Yücel

Atak

et al. 2015

Ulus Travma Acil Cerrahi Derg

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“…Intra-abdominal perihepatic packing can be life saving in refractory hemorrhage associated with coagulopathy, hypothermia and acidosis [19,20]. The avoidance of extensive liver surgery in a decompensated patient may have improved the mortality rates compared to historical controls [19][20][21][22]. In our study suture hepatorraphy was more common because it was a coincidental operation when operating for other hollow viscus injuries.…”

Section: Management Of Complicationsmentioning

confidence: 77%

Complex Hepatic Injuries: an Audit from a Tertiary Center

Thiagarajan

Wig

Gupta

et al. 2007

Eur J Trauma Emerg Surg

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“…Hepatic artery angiography should be used when CT scan suggests an intrahepatic arterial bleed or high-grade injury in the management of hepatic injuries [9]. Selective arterial embolization of blunt hepatic trauma is considered to be the gold standard care for hemodynamically stable patients with higher grade injuries or the evidence of contrast blush visible in CT scan [10,11]. It is considered as a conservative management as well as adjunct to surgery in cases of severe injury [12].…”

Section: Discussionmentioning

confidence: 99%

Selective arterial embolization in hepatic trauma

John¹,

Varkey²

2014

IJCRI

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International Journal of Case Reports and Images (IJCRI) is an international, peer reviewed, monthly, open access, online journal, publishing high-quality, articles in all areas of basic medical sciences and clinical specialties.Aim of IJCRI is to encourage the publication of new information by providing a platform for reporting of unique, unusual and rare cases which enhance understanding of disease process, its diagnosis, management and clinico-pathologic correlations.IJCRI publishes Review Articles, Case Series, Case Reports, Case in Images, Clinical Images and Letters to Editor. Website: www.ijcasereportsandimages.com Selective arterial embolization in hepatic traumaFred John, Mary Rithu Varkey ABSTRACT Introduction: Blunt abdominal trauma accounts for about (80%) of abdominal injuries seen in the emergency department. The spleen and liver are the most commonly injured solid organs in a blunt abdominal trauma. There has been a change in the trend towards the conservative management of liver injuries with improvement of the imaging techniques. Nowadays nonoperative management has been preferred as the treatment of choice in hemodynamically stable cases of liver injuries. Transarterial embolization has been introduced as an effective tool for the management of hemodynamically stable patients with blunt hepatic trauma. This case illustrates the potential benefits of using hepatic artery embolization technique as a treatment modality in patients in whom active surgical intervention was not successful. Case Report: A 21-year-old male presented to the emergency department with alleged history of fall from a building. On examination the patient was conscious and oriented, hypotensive, tachycardia and generalized abdominal tenderness. Focused assessment with sonography for trauma (FAST) was positive. So an emergency ultrasonography and contrast-enhanced computed tomography (CECT) scan of the abdomen were done which revealed gross hemoperitoneum with liver lacerations. Patient underwent an exploratory laparotomy, the surgeon was not able control the bleeding. So the patient was shifted to cath lab for an emergency hepatic artery embolization with gel foam. Bleeding was controlled with the procedure and he was discharged after two weeks. Conclusion:The non-operative management of blunt hepatic trauma is considered to be the gold standard care for hemodynamically stable patients. Since angiography can offer both diagnostic and therapeutic benefits, angiography should be considered in localizing the site of hemorrhage and in providing an opportunity for the interventional radiologist to proceed to transcatheter embolization of bleeding sites.

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Operative Management and Outcomes in 103 AAST-OIS Grades IV and V Complex Hepatic Injuries: Trauma Surgeons Still Need to Operate, but Angioembolization Helps

Abstract: Improvements in mortality can be achieved with an appropriate operative approach. Angioembolization as an adjunct procedure decreases mortality in AAST-OIS grades IV and V hepatic injuries.

Cited by 166 publications

References 32 publications

Multivariate analysis of patients with blunt trauma and possible factors affecting mortality

Multivariate analysis of patients with blunt trauma and possible factors affecting mortality

Complex Hepatic Injuries: an Audit from a Tertiary Center

Selective arterial embolization in hepatic trauma

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