Treatment Strategy for Blunt Hepatic Trauma: Analysis of 183 Consecutive Cases

Ochiai, Takanori; Igari, Kimihiro; Yagi, Masayuki; Ito, Hiromitsu; Kumagai, Yoshito; Iida, Michio; Matsumoto, Akinori; Kumada, Yoshifumi; Shinohara, Kazuhiko; Yamazaki, Shigeru

doi:10.5754/hge11042

Cited by 15 publications

(20 citation statements)

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“…However, the mechanism of hepatic subcapsular hematoma following P‐ESWL is quite different from that of trauma. Most patients who develop hepatic subcapsular hematoma owning to trauma sustain capsular tears, lacerations or burst‐type injuries to the liver and require arterial embolism or surgical intervention . However, during the P‐ESWL procedure, shock waves are targeted to pancreatic stones hence less force spreads to adjacent tissues and the injury to other tissues is limited.…”

Section: Discussionmentioning

confidence: 99%

Hepatic subcapsular hematoma breaking into the abdominal cavity after extracorporeal shock wave lithotripsy for pancreatic stones

Wang

et al. 2018

J of Digest Diseases

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Section: Discussionmentioning

confidence: 99%

Hepatic subcapsular hematoma breaking into the abdominal cavity after extracorporeal shock wave lithotripsy for pancreatic stones

Wang

et al. 2018

J of Digest Diseases

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“…TAE is an essential treatment procedure in the management of blunt hepatic injury and has been universally adopted for patients who are hemodynamically stable [1][2][3][4][5]. Its safety is attributed to the dual blood supply to the hepatic parenchyma via the portal vein and hepatic artery.…”

Section: Discussionmentioning

confidence: 99%

“…Transcatheter arterial embolization (TAE) for hemodynamically stable patients with blunt hepatic trauma has become a safe and standard therapeutic procedure, and is widely performed [1][2][3][4][5]. Hepatic infarction after TAE is unusual because of the dual blood supply to the hepatic parenchyma via the portal vein and hepatic artery.…”

Section: Introductionmentioning

confidence: 99%

Fatal Hepatic Necrosis after Transcatheter Arterial Embolization for Blunt Hepatic Trauma

Toguchi¹,

Tajima²,

Hagiwara³

et al. 2015

JCR

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Abstract:Hepatic necrosis after transcatheter arterial embolization (TAE) is rare because of the dual blood supply to the hepatic parenchyma via the portal vein and hepatic artery. We describe a patient with blunt hepatic injury who had a portal-systemic venous shunt in the right posterior segment of the liver and who suffered a fatal hepatic necrosis after TAE. A 74-year-old female with blunt hepatic injury was treated by TAE: both the right hepatic artery and middle hepatic artery were embolized using gelatin sponge particles. She developed multiple organ failure and died four days after the TAE. Autopsy revealed massive necrosis in the right lobe and left medial segment of the liver. To the best of our knowledge, this is the first report of hepatic necrosis after TAE for blunt liver trauma related to a portal-systemic venous shunt.

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“…There were no mortalities in our series; overall mortality from liver trauma in the literature is approximately 9% [10] but ranges from 33% to 50% following anatomical resection in the context of injury [11,26]. …”

Section: Discussionmentioning

confidence: 99%

Outcomes following liver trauma in equestrian accidents

Balakrishnan

Abbadi

Oakland

et al. 2014

J Trauma Manage Outcomes

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BackgroundEquestrian sports are common outdoor activities that may carry a risk of liver injury. Due to the relative infrequency of equestrian accidents the injury patterns and outcomes associated with liver trauma in these patients have not been well characterized.MethodsWe examined our experience of the management of equestrian liver trauma in our regional hepatopancreaticobiliary unit at a tertiary referral center. The medical records of patients who sustained liver trauma secondary to equestrian activities were analysed for parameters such as demographic data, liver function tests, patterns of injury, radiological findings, the need for intervention and outcomes.Results20 patients sustained liver trauma after falling from or being kicked by a horse. The majority of patients were haemodynamically stable on admission. Alanine transaminase (ALT) levels were elevated in all patients and right-sided rib fractures were a frequently associated finding. CT demonstrated laceration of the liver in 12 patients, contusion in 3 and subcapsular haematoma in 2. The right lobe of the liver was most commonly affected. Only two patients required laparotomy and liver resection; the remaining 18 were successfully managed conservatively.ConclusionsThe risk of liver injury following a horse kick or falling off a horse should not be overlooked. Early CT imaging is advised in these patients, particularly in the presence of high ALT levels and concomitant chest injuries such as rib fractures. Despite significant liver trauma, conservative management in the form of close observation, ideally in a high-dependency setting, is often sufficient. Laparotomy is only rarely warranted and associated with a significantly higher risk of post-operative bile leaks.

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Treatment Strategy for Blunt Hepatic Trauma: Analysis of 183 Consecutive Cases

Abstract: The results of anatomical resection for grade IV is satisfactory, but additional strategies are still required for grade V.

Cited by 15 publications

References 0 publications

Hepatic subcapsular hematoma breaking into the abdominal cavity after extracorporeal shock wave lithotripsy for pancreatic stones

Hepatic subcapsular hematoma breaking into the abdominal cavity after extracorporeal shock wave lithotripsy for pancreatic stones

Fatal Hepatic Necrosis after Transcatheter Arterial Embolization for Blunt Hepatic Trauma

Outcomes following liver trauma in equestrian accidents

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