Actualización del tratamiento de los traumatismos hepáticos

Silvio-Estaba, Leonardo; Madrazo-González, Zoilo; Ramos, Emilio

doi:10.1016/s0009-739x(08)70559-1

Cited by 14 publications

(13 citation statements)

References 69 publications

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“…At the beginning of the 1990’s several articles reported the possibility of non surgical treatment in patients with hemodynamic stability similar to what is carried out by pediatric surgeons in cases of hepatic-splenic injuries [9, 12]. The aim of this type of treatment is to thereby not only decrease the number of non therapeutic laparotomies [13-15] but also to achieve a reduction in the values of morbi-mortality. In this group of patients immediate surgery is substituted by initial non surgical treatment with close patient supervision.…”

Section: Discussionmentioning

confidence: 99%

Treatment of Liver Trauma: Operative or Conservative Management

et al. 2010

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BackgroundThe liver is one of the most frequently damaged organs when abdominal trauma occurs. Currently, a conservative management constitutes the treatment of choice in patients with hemodynamic stability. The aim of this study is to evaluate the results of an operative and conservative management of 143 patients with liver injury treated in a single institution.MethodsA retrospective study of the patients admitted with the diagnosis of liver trauma was performed from 1992-2008. The patients were classified according to the intention to treatment: Group I, operative management; Group II, conservative management. Variables analyzed included demographic data, injury classification, associated lesions, surgical treatment, transfusions, morbi-mortality, and hospital stay. We established two periods (1992-1999; 2000-2008) in order to compare diagnosis and management.ResultsA total of 143 patients were analyzed. Thirty-one percent correspond to severe injuries. Conservative treatment was followed in 60.8 % with surgery undertaken in 14.9 % of patients from this group due to failure of conservative treatment. Immediate surgery was carried out in 38.2 %. Total mortality was 14 %. Morbidity (35.7-38.5 %) in the group of immediate surgery and failure of conservative management is similar, but not in mortality (28.6-15.4 %). In the second group (2000-2008) there are more patients with conservative treatment, with a low percentage of failure of this treatment and morbi-mortality.ConclusionsConservative treatment is an adequate treatment in a great number of patients. Failure of conservative treatment did not show a higher incidence of complications or mortality but it should be performed in centers with experienced surgeons.

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Section: Discussionmentioning

confidence: 99%

Treatment of Liver Trauma: Operative or Conservative Management

et al. 2010

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“…Por outro lado, quedas da própria altura podem ser importante causa de trauma hepático em idosos, possuindo outros mecanismos associados [3,4].…”

Section: /6unclassified

“…Já lesões do lobo esquerdo são raras e, quando presentes, geralmente estão associadas com impacto direto no abdome superior. As lesões do lobo caudado são extremamente raras e geralmente estão associadas a traumas de outros órgãos [4,15]. No presente estudo observou-se a predominância do lobo hepático direito, porém a coleta de dados foi prejudicada nesse quesito, pela escassez de informações na maioria dos documentos analisados.…”

Section: /6unclassified

“…O fígado está acometido em aproximadamente 5% das admissões por trauma em serviço de urgência, correspondendo a um dos órgãos mais afetados, principalmente devido ao seu tamanho e sítio anatômico, apresentando o trauma abdominal fechado como o principal mecanismo de lesão [2][3][4].…”

Section: Introductionunclassified

“…As taxas de mortalidade são bastante altas, variando entre 10 e 30% para trauma fechado e 5 a 10% para trauma hepático penetrante. A mortalidade em pacientes com trauma hepático situase entre 4 e 15%, dependendo do tipo de lesão e da afecção simultânea de outros órgãos [4].…”

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Trauma hepático: prevalência e características epidemiológicas de vítimas encaminhadas ao Instituto Médico Legal de Palmas, Tocantins

Castro

Ferreira

Pereira

et al. 2015

Sci Med

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RESUMO ABSTRACTAims: To assess the prevalence and epidemiological characteristics of hepatic trauma in victims referred to the Forensic Department of Palmas, State of Tocantins, Brazil. Methods: A retrospective cross-sectional study was performed with all the victims referred to the Forensic Department of Palmas from January 2006 to December 2010, to investigate violent deaths with severe damage to the liver tissue. The data were collected from the Forensic Department records. The following data were evaluated: sex, age, mechanism of injury (in case of motor vehicle accidents, the type of vehicle involved), types of trauma associated with abdominal trauma, presence of abdominal lesions associated with hepatic injury, the American Association for the Surgery of Trauma Organ Injury Scale, and number of deaths caused directly by hepatic trauma. The statistical analysis included absolute and relative frequencies of the variables. Results: A total of 241 (13.4%) out of 1,796 victims had liver trauma, among whom 85.5% were male and 42.9% belonged to the 21-30 year age group. Motor vehicle accidents were the major cause of trauma in 143 cases, (59.3%), involving mainly motorcycles (53 cases or 37%). Blunt trauma was the most frequent mechanism of injury, having occurred in 179 cases (74.3%). The right lobe was injured in 98 cases (40.7%). A total of 147 victims (61%) had polytrauma. Splenic injury, present in 65 (27%) of the cases, was mostly associated with liver trauma. Liver injury of grade II was detected in 102 cases (42.4%) and was therefore the most prevalent type of damage. Twenty-one (8.7%) deaths were directly related to liver trauma. Conclusions: Blunt injury, caused mainly by motor vehicle accidents (especially with motorcycles), was the most common type of liver trauma observed in violent deaths, according to the records of the Forensic Department of Palmas. Young men of working age were the most frequent victims with liver trauma.KEY WORDS: liver; wounds and injuries; traumatology; epidemiology; accidents, traffic. Scientia Medica Artigo originAlOpen Access 2015;25(1):ID19737 ISSN 1980ISSN -6108 : http://dx.doi.org/10.15448/1980ISSN -6108.2015 Recebido: janeiro,

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