Hepatic trauma

Abstract

Management of trauma-related liver injury has undergone a paradigm shift over the past four decades. In hemodynamically stable patients, the standard of care in the majority of level-one trauma centers has shifted to nonoperative management with high success rates, especially with low-grade liver injuries (i.e., grade I and II liver injuries). Advances in critical care medicine, cross-sectional imaging, and transarterial embolization techniques have led to the improvement of patient outcomes and decreased mortality rates in patients with arterial injuries. Currently, no consensus guidelines on appropriate patient selection criteria have been published by the Society of Interventional Radiology (SIR) or the American Association for the surgery of Trauma (AAST). Based off the current literature, nonoperative management with hepatic angiography and transarterial embolization (TAE) should be the treatment of choice in hemodynamically stable patients with clinical suspicion of arterial injury. TAE has been shown to improve success rates of nonoperative management and is well tolerated by most patients with low complication rates. Hepatic necrosis is the most common and concerning reported complication but can be reduced with selective approach and choice of embolic agent. The majority of literature supporting the use of TAE for traumarelated liver injury consists of retrospective case series and additional larger scale studies are needed to determine the efficacy of TAE in this setting. However, it is clear from the current literature that hepatic TAE is an effective and safer option to operative management in treating arterial hemorrhage in the setting of traumatic hepatic injury.

Post biopsy delayed liver hemorrhage successfully controlled by bedside CEUS‐guided microwave ablation: A case report

“…Angiographic embolization and surgical intervention are performed prior to arterial bleeding. 18 Venorrhaphy and ligation are performed prior to portal bleeding. 19 Although MWA is not routinely performed for the treatment of hemorrhage, it is an alternative to control bleeding at the bedside in some high‐volume institutes.…”

“…Angiographic embolization and surgical intervention are performed prior to arterial bleeding 18 . Venorrhaphy and ligation are performed prior to portal bleeding 19 .…”

Blunt inferior vena cava injury associated with AAST-grade V hepatic and renal injuries: A case report

“…In our case, the blood creatinine level of the patient was 0.57 mg/dL at the emergency room, up to 7.23 mg/dL on the 10 th ~ 98 ~ day post-ligation of the right renal vein, and down to the normal value (0.46 mg/dL) on the 30 th day. For liver trauma, nonoperative management is the treatment of choice in the hemodynamic ally stable patients [10] . Trans arterial embolization (TAE) is recommended for clinical suspicion of hepatic arterial injury.…”

Importance of Anatomical Variation of the Hepatic Artery for Complicated Liver and Pancreatic Surgeries: A Review Emphasizing Origin and Branching

“…With new advances in imaging with the MDCT, the non-operative management of blunt liver trauma is considered the treatment of choice in hemodynamically stable patients [ 99 , 100 ]. Transarterial angioembolization is considered the gold-standard non-operative technique in the management of traumatic liver injury with a high success rate [ 101 ]. CT angiography and angioembolization are key components of the non-operative management of blunt liver injuries.…”