A multidisciplinary approach in the management of hepatic injuries

Sriussadaporn, Suvit; Pak‐art, Rattaplee; Tharavej, Chadin; Sirichindakul, Boonchoo; Chiamananthapong, Sathaporn

doi:10.1016/s0020-1383(02)00074-8

Cited by 33 publications

(26 citation statements)

References 31 publications

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“…The decrease in incidence of penetrating trauma in Brazil can be explained by an improvement in the political control of urban violence in some regions, and the relative prevalence of blunt trauma is associated with an increased number of motor vehicles and motorcycles circulating in the country in recent decades, with a higher incidence of traffic victims 28 . Mortality from liver trauma ranges from 9 to 42%, and in most studies is close to 20% when considering all cases admitted to hospital 2,4,5,10,11,14,18,20 . In this study the mortality rate of 19.9% is in accordance with the literature.…”

Section: Results Results Results Resultsmentioning

confidence: 99%

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Trauma hepático: uma experiência de 21 anos

Zago

Pereira

Nascimento

et al. 2013

Rev. Col. Bras. Cir.

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OBJETIVO: avaliar os aspectos epidemiológicos, conduta, morbidade e resultados do tratamento trauma hepático. MÉTODOS: estudo retrospectivo de doentes com mais de 13 anos de idade admitidos em um hospital universitário de 1990 a 2010, submetidos ao tratamento cirúrgico ou não operatório (TNO). RESULTADOS: foram admitidos 748 pacientes com trauma hepático. O mecanismo de trauma mais frequente foi o trauma penetrante (461 casos; 61,6%). O trauma fechado ocorreu em 287 pacientes (38,4%). De acordo com o grau de lesão hepática (AAST-OIS), no trauma fechado foi observada uma predominância dos graus I e II e no trauma penetrante, uma predominância do grau III. O TNO foi realizado em 25,7% dos pacientes com trauma hepático contuso. Entre os procedimentos cirúrgicos, a sutura foi realizada com maior frequência (41,2%). A morbidade relacionada ao fígado foi 16,7%. A taxa de sobrevida para pacientes com trauma hepático fechado foi 73,5% e no trauma penetrante de 84,2%. A mortalidade no trauma complexo foi 45,9%. CONCLUSÃO: o trauma permanece mais incidente nas populações mais jovens e no sexo masculino. Houve uma redução dos traumas hepáticos penetrantes. O TNO se mostrou seguro e efetivo, e, frequentemente, foi empregado para tratar os pacientes com trauma hepático penetrante. A morbidade foi elevada e a mortalidade foi maior em vítimas de traumas contusos e em lesões hepáticas complexas.

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Section: Results Results Results Resultsmentioning

confidence: 99%

“…Complex hepatic injuries treated operatively have a high morbidity rate. Improvements in mortality can be achieved using damage control principles and an appropriate surgical approach 5 .…”

Section: Introduction Introduction Introduction Introduction Introducmentioning

confidence: 99%

Trauma hepático: uma experiência de 21 anos

Zago

Pereira

Nascimento

et al. 2013

Rev. Col. Bras. Cir.

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“…Johnson et al revealed this in their series of 19/37 patients with packing, 9 of whom underwent angiography, and their therapeutic liver angiography rate was 75% (6). AE as an adjunct may decrease the mortality in severe liver trauma (6,18). Richardson and colleagues attributed improved survival to several factors.…”

Section: Grade 3 4 17mentioning

confidence: 97%

“…In the postoperative period, it is often difficult to differentiate active hemorrhage of parenchymal vessels from non-mechanical, coagulopathic bleeding. Patients with severe liver trauma have a high risk of arterial bleeding deep from liver, and after packing an additional angiographic procedure may be required (17,18). The rationale for angiography is to detect and eliminate a ruptured intrahepatic hematoma due to bleeding branches of hepatic artery (18).…”

Section: Grade 3 4 17mentioning

confidence: 99%

“…Patients with severe liver trauma have a high risk of arterial bleeding deep from liver, and after packing an additional angiographic procedure may be required (17,18). The rationale for angiography is to detect and eliminate a ruptured intrahepatic hematoma due to bleeding branches of hepatic artery (18). Johnson et al revealed this in their series of 19/37 patients with packing, 9 of whom underwent angiography, and their therapeutic liver angiography rate was 75% (6).…”

Section: Grade 3 4 17mentioning

confidence: 99%

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Hasar Kontrol Cerrahi̇si̇ Sonrasi Anji̇yografi̇ Ruti̇n Olarak Yapilmali Midir?

Yanar

Özçınar

Sivrikoz³

et al. 2017

İstanbul Tıp Fakültesi Dergisi

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Objective:The management of traumatic liver injuries involves various strategies ranging from observation to operative intervention and includes various options such as angiography and/or damage-control surgery. In this study, we aimed to clarify whether routine angiography is necessary or can be reserved for selected patients with persistent bleeding after depacking. Methods: During the 11-year period from January 2000 to December 2010 all patients with blunt or penetrating trauma who sustained a liver injury and underwent a damage control laparotomy in our institution were retrospectively reviewed. Following variables were extracted from patient charts: demographics, the mechanism of injury, shock status, Injury Severity Score, liver injury grades, associated injuries, angioembolization, duration of hospitalisation, time to depacking, mortality. Angioembolization.was performed when persistent bleeding was encountered after depacking. Results: A total of 513 patients with hepatic injury were admitted during the study period. Damage control surgery was undertaken in 60 patients, of whom 21 patients underwent angioembolization. The factors associated with a high Injury Severity Score were admission in shock status (p=0.009) and associated organ injuries (p<0.001). Extremity injury was the most commonly encountered associated injury (n=15, 25.0%). In the damage control surgery group, mortality was not significantly different between angioembolization (n=4, 19%) and non-angioembolization (n=14, 33%) groups (p=0.369). Conclusion:The most patients with abdominal packing after liver trauma may not require routine angiography. Angioembolization may be used selectively in patients with persistent bleeding after depacking.

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