Contemporary Management of Hepatic Trauma: What IRs Need to Know

Abstract

Trauma remains one of the leading causes of death in the United States in patients younger than 45 years. Blunt trauma is most commonly a result of high-speed motor vehicular collisions or high-level fall. The liver and spleen are the most commonly injured organs, with the liver being the most commonly injured organ in adults and the spleen being the most affected in pediatric blunt trauma. Liver injuries incur a high level of morbidity and mortality mostly secondary to hemorrhage. Over the past 20 years, angiographic intervention has become a mainstay of treatment of hepatic trauma. As there is an increasing need for the interventional radiologists to embolize active hemorrhage in the setting of blunt and penetrating hepatic trauma, this article aims to review the current level of evidence and contemporary management of hepatic trauma from the perspective of interventional radiologists. Embolization techniques and associated outcome and complications are also reviewed.

Management of severe liver injuries: push, pack, pringle – and plug!

“…One is the failure of non-operative management despite angioembolization. Hence, clinical vigilance must always be exercised in the team and the interventional radiologist should know the limits [ 22 ]. Also, there are a number of potential complications that may develop from angioembolization as well.…”

Basic Principles of Trauma Embolization

“…14 On the other hand, all hemodynamically unstable patients require emergent surgical management, which includes four quadrant packing, ligation of bleeding vessels, possible hepatic lobectomy, and repair of venous injury under total vascular isolation. 22,23 Patients who suffer severe injury but are hemodynamically stable, and have evidence of ongoing bleeding with an identified arterial source of bleeding on CT angiography, benefit from endovascular embolization. In some of these patients, nonemergent biloma drainage may also be necessary.…”

Delayed and Chronic Sequelae of Trauma and the Role of the Interventional Radiologist

“…6 Patients undergoing posttrau-matic cholecystectomy with cystic duct injury are also at high risk. 7,8 Percutaneous drainage is an effective treatment. 9 Drainage may be required for a month or more, in particular for high-output leaks of !…”