The role of computed tomographic scan in ongoing triage of operative hepatic trauma

Kutcher, Matthew; Weis, Joshua J.; Siada, Sammy; Kaups, Krista L.; Kozar, Rosemary A.; Wawrose, Richard A.; Summers, Jessica I.; Eriksson, Evert A.; Leon, Stuart; Carrick, Matthew M.; Mallory, Gina R; Sperry, Jason L.

doi:10.1097/ta.0000000000000692

Cited by 22 publications

(13 citation statements)

References 12 publications

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“…After laparotomy, persistent transfusion requirements usually suggest need for angiography and embolization. In this setting additional imaging can be helpful, as early post-operative CT has been found to determine which patients would require post-laparotomy angioembolization with high sensitivity and specificity 56 .…”

Section: Discussionmentioning

confidence: 99%

Outcomes and complications of angioembolization for hepatic trauma

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Bulger

Kwan

2016

Journal of Trauma and Acute Care Surgery

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Background The liver is one of the most frequently injured abdominal organs. Hepatic hemorrhage is a complex and challenging complication following hepatic trauma. Significant shifts in the treatment of hepatic hemorrhage, including the increasing use of angioembolization, are believed to have improved patient outcomes. We aimed to describe the efficacy of angioembolization in the setting of acute hepatic arterial hemorrhage, as well as the complications associated with this treatment modality. Methods A systematic review of published literature (MEDLINE, SCOPUS, and Cochrane Library) describing hepatic angioembolization in the setting of trauma was performed. Articles that fulfilled the predetermined inclusion and exclusion criteria were included. We analyzed the efficacy rate of angioembolization in the setting of traumatic hepatic hemorrhage as well as the complications associated with hepatic angioembolization. Results Four hundred and fifty nine articles were identified in the literature search. Of these, 10 retrospective studies and 1 prospective study met inclusion and exclusion criteria. Efficacy rate of angioembolization was 93%. The most frequently reported complications following hepatic angioembolization included hepatic necrosis (15%), abscess formation (7.5%), and bile leaks. Conclusion Although the outcomes of hepatic angioembolization were generally favorable with a high success rate, the treatment modality is not without associated morbidity. The most frequently associated major complication was hepatic necrosis. Rates of complications were affected by study heterogeneity and should be better defined in future studies.

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Section: Discussionmentioning

confidence: 99%

Outcomes and complications of angioembolization for hepatic trauma

Green

Bulger

Kwan

2016

Journal of Trauma and Acute Care Surgery

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“…Multidetector computed tomography plays a pivotal role in triaging for the angiography in patients with active arterial hemorrhage and pseudoaneurysm both before and in early postoperative phase 34 (Figure 11). The importance of active extravasation of contrast has been demonstrated in multiple studies, and usually, its presence indicated urgent surgical intervention.…”

Section: Approach To Visceral Injuriesmentioning

confidence: 99%

Dual-Energy CT: A Paradigm Shift in Acute Traumatic Abdomen

et al. 2020

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Abdominal trauma, one of the leading causes of death under the age of 45, can be broadly classified into blunt and penetrating trauma, based on the mechanism of injury. Blunt abdominal trauma usually results from motor vehicle collisions, fall from heights, assaults, and sports and is more common than penetrating abdominal trauma, which is usually seen in firearm injuries and stab wounds. In both blunt and penetrating abdominal trauma, an optimized imaging approach is mandatory to exclude life-threatening injuries. Easy availability of the portable ultrasound in the emergency department and trauma bay makes it one of the most commonly used screening imaging modalities in the abdominal trauma, especially to exclude hemoperitoneum. Evaluation of the visceral and vascular injuries in a hemodynamically stable patient, however, warrants intravenous contrast-enhanced multidetector computed tomography scan. Dual-energy computed tomography with its postprocessing applications such as iodine selective imaging and virtual monoenergetic imaging can reliably depict the conspicuity of traumatic solid and hollow visceral and vascular injuries.

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“…In patients with abdominal trauma who are hemodynamically stable, CT with intravenous contrast material is the imaging modality of choice (17), but the optimal use of imaging in patients undergoing DCS without preoperative imaging is an area of continued study (18)(19)(20)(21)(22)(23). A CT examination performed in the early perioperative period may allow identification of injuries that require additional intervention or occult injuries in or beyond the surgical field and may provide the potential to change the patient treatment plan.…”

Section: Imaging After Dcsmentioning

confidence: 99%

“…A CT examination performed in the early perioperative period may allow identification of injuries that require additional intervention or occult injuries in or beyond the surgical field and may provide the potential to change the patient treatment plan. Recent studies have shown that approximately 10%-30% of patients who undergo DCS undergo CT within 48 hours of surgery (19,(21)(22)(23).…”

Section: Imaging After Dcsmentioning

confidence: 99%

“…Surgical control of hepatic hemorrhage can be especially difficult to maintain because of coagulopathy, and the hepatic parenchyma is not as tolerant of emergency resection as is the bowel or spleen. Kutcher et al (19) studied patients with hepatic injuries after DCS who did not undergo preoperative imaging. Of the 528 patients included in the study, 123 patients underwent CT within 24 hours of surgery, and 8% of that group had hepatic active extravasation or a pseudoaneurysm.…”

Section: Ongoing Hemorrhagementioning

confidence: 99%

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Multidetector CT Findings in the Abdomen and Pelvis after Damage Control Surgery for Acute Traumatic Injuries

et al. 2019

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After experiencing blunt or penetrating trauma, patients in unstable condition who are more likely to die of uncorrected shock than of incomplete injury repairs undergo emergency limited exploratory laparotomy, which is also known as damage control surgery (DCS). This surgery is part of a series of resuscitation steps, with the goal of stabilizing the patient's condition, with rapid surgical control of hemorrhage followed by supportive measures in the intensive care unit before definitive repair of injuries. These patients often are imaged with multidetector CT within 24-48 hours of the initial surgery. Knowledge of this treatment plan is critical to CT interpretation, because there are anatomic derangements and foreign bodies that would not be present in patients undergoing surgery for other reasons. Patients may have injuries beyond the surgical field that are only identified at imaging, which can alter the care plan. Abnormalities related to the resuscitation period such as the CT hypoperfusion complex and ongoing hemorrhage can be recognized at CT. Familiarity with these imaging and clinical findings is important, because they can be seen not only in trauma patients after DCS but also in other patients in the critical care setting. The interpretation of imaging studies can be helped by an understanding of the diagnostic challenges of grading organ injuries with surgical materials in place and the awareness of potential artifacts on images in these patients.

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The role of computed tomographic scan in ongoing triage of operative hepatic trauma

Abstract: Care management/therapeutic study, level IV; epidemiologic/prognostic study, level III.

Cited by 22 publications

References 12 publications

Outcomes and complications of angioembolization for hepatic trauma

Outcomes and complications of angioembolization for hepatic trauma

Dual-Energy CT: A Paradigm Shift in Acute Traumatic Abdomen

Multidetector CT Findings in the Abdomen and Pelvis after Damage Control Surgery for Acute Traumatic Injuries

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