Current approach to liver traumas

Kaptanoğlu, Levent; Kurt, Necmi; Sıkar, Hasan Ediz

doi:10.1016/j.ijsu.2017.02.015

Cited by 40 publications

(34 citation statements)

References 38 publications

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“…A recent study from Albania reported a similar rate of successful conservative management (83%) [ 3 ]. Another study from Turkey [ 24 ] included 300 patients (63% stable and 37% unstable), of them 192 patients treated conservatively and 108 received surgery. In this study, 13% died and the main determinants of mortality were hemodynamic instability on admission and type and grade of liver injury [ 24 ].…”

Section: Discussionmentioning

confidence: 99%

Blunt liver trauma: a descriptive analysis from a level I trauma center

Afifi

Abayazeed²,

El‐Menyar

et al. 2018

BMC Surg

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BackgroundWe aimed to review liver injury experience in a level 1 trauma center; namely clinical presentation, grading, management approach and clinical outcomes.MethodsIt is a retrospective analysis to include all blunt liver injury patients who were admitted at the Level 1 trauma center over a 3-year period. Data were compared and analyzed based on the liver injury grades and management approaches.ResultsBlunt liver injury accounted for 38% of the total blunt abdominal trauma cases with a mean age of 31 ± 13 years. Liver injury grade II (44.7%) was most common followed by grade I (28.8%), grade III (19.1%), grade IV (7.0%) and grade V (0.4%). Blood transfusion was more frequently required in patients with grade IV (p = 0.04). Out of 257 patients with blunt liver trauma, 198 were initially treated conservatively, that was successful in 192 (97%), whereas it failed in 6 (3%) patients due to delayed bleeding from hepatic hematoma, associated splenic rupture and small bowel injury which mandate surgical intervention. Fifty-nine patients (23%) underwent emergent surgery in terms of packing, resection debridement, left lobe hepatectomy and splenectomy. Hepatic complications included biloma, pseudoaneurysm and massive liver necrosis. Subanalysis of data using the World Society of Emergency Surgery (WSES) classification revealed 19 patients were categorized as a WSES grade IV who needed surgical intervention without having an initial computerized tomography scanning. The overall mortality was 7.8% which was comparable among the conservative and operative group.ConclusionsIn our center, low grade liver injury in young males prevails. NOM is successful even for high graded injuries. All conservatively treated patients with high-grade liver injuries should be closely monitored for signs of failure of the non-operative management. Introducing the new WSES classification makes clear how is important the hemodynamic status of the patients despite the lesion. However, further larger prospective and multicenter studies are needed to support our findings.

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Section: Discussionmentioning

confidence: 99%

Blunt liver trauma: a descriptive analysis from a level I trauma center

Afifi

Abayazeed²,

El‐Menyar

et al. 2018

BMC Surg

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“…Until now, several agents have been identified to be applied on injured liver. Hemostatic agents, such as surgicell, thrombin-soaked gel foam, or fibrin glue are useful adjuncts [43]. However, these favorable agents have their own complications like bile leakage and rebleeding [44, 45].…”

Section: Discussionmentioning

confidence: 99%

Stereological Comparison of Imbibed Fibrinogen Gauze versus Simple Gauze in External Packing of Grade IV Liver Injury in Rats

Paydar

Nezhad

Karami

et al. 2019

BEAT

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Objective:To evaluate the effect of imbibed fibrinogen gauze on survival, bleeding and healing in liver trauma.Methods: This animal experimental study was conducted on 20 adult male Sprague-Dawley rats; with a mean weight of 300±50 gram; divided into two groups. Grade IV injury was induced to the subjects’ liver. Then, the bleeding site was packed with simple gauze in the control group, and imbibed fibrinogen gauze in the experimental group. All animals were re-evaluated for liver hemostasis 48 hours after the initial injury. Bleeding in the intra peritoneal cavity was measured using Tuberculosis Syringe in the first and second operations. Subjects were followed-up for 14 days. Eventually, the rats were sacrificed and their livers were sent to a lab for stereological assessment. Statistical comparisons were performed via Mann–Whitney U-test using SPSS. P-Values less than 0.05 were considered to be statistically significant.Results:Half of the rats in the control group died, while all the rats in the imbibed fibrinogen gauze group survived after two weeks (p= 0.032). Bleeding in the imbibed fibrinogen gauze was significantly less than control group, 48 hours’ post-surgery (p<0.001). According to the stereological results, granulation tissue in the imbibed fibrinogen gauze group were more than the control group (P= 0.032). Also, fibrosis in the imbibed fibrinogen gauze group were more than the control group (P= 0.014).Conclusion: Our study indicated that imbibed fibrinogen gauze can potentially control liver bleeding and improve survival through increasing granulation tissue and fibrosis in injured liver.

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“…From patient-to-patient, gunshot trauma is managed based on the case scenario. It is not uncommon for penetrating injury to be managed by surgical intervention, especially if the patient is hemodynamically unstable [ 4 ]. However, surgical intervention of a foreign body (bullet) could also be contraindicated, as it could lead to further damage of the patient’s surrounding structures.…”

Section: Discussionmentioning

confidence: 99%

I Want My Bullet Back: Percutaneous Endovascular Removal of a Right Atrial Foreign Body

Harmon

Loper

Matteo

2018

Cureus

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The incidence and prevalence of firearm-related homicide in the United States make headlines daily. As a result, an epidemic of penetrating injuries is on the rise. Specifically, foreign bodies such as bullets and shrapnel are usually left inside the human body due to penetrating injuries, unless they are in close proximity to vital structures. We present a case of a bullet within the right atrial chamber of the heart, which was successfully removed by a minimally invasive endovascular approach.

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Current approach to liver traumas

Cited by 40 publications

References 38 publications

Blunt liver trauma: a descriptive analysis from a level I trauma center

Blunt liver trauma: a descriptive analysis from a level I trauma center

Stereological Comparison of Imbibed Fibrinogen Gauze versus Simple Gauze in External Packing of Grade IV Liver Injury in Rats

I Want My Bullet Back: Percutaneous Endovascular Removal of a Right Atrial Foreign Body

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