Management of blunt hepatic and splenic trauma in Austria: a national questionnaire study

Fodor, Margot; Primavesi, Florian; Morell-Hofert, Dagmar; Haselbacher, Matthias; Braunwarth, Eva; Cardini, Benno; Gassner, Eva; Öfner, Dietmar; Stättner, Stefan

doi:10.1007/s10353-019-0586-9

Cited by 4 publications

(7 citation statements)

References 33 publications

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“…Modern coagulation management, including thromboelastography to guide blood product resuscitation, contributed to improved outcomes for NOM at our center. According to an Austrian survey in 2016, the rate of NOM was > 50% in more than two thirds of all national hospitals and an increasing trend towards radiologic interventions was reported [30].…”

Section: Discussionmentioning

confidence: 99%

Non-operative management of blunt hepatic and splenic injury: a time-trend and outcome analysis over a period of 17 years

et al. 2019

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Background A widespread shift to non-operative management (NOM) for blunt hepatic and splenic injuries has been observed in most centers worldwide. Furthermore, many countries introduced safety measures to systematically reduce severe traffic and leisure sports injuries. This study aims to evaluate the effect of these nationwide implementations on individual patient characteristics and outcomes through a time-trend analysis over 17 years in an Austrian high-volume trauma center. Methods A retrospective review of all emergency trauma patients admitted to the Medical University of Innsbruck from 2000 to 2016. Injury severity, clinical data on admission, operative and non-operative treatment parameters, complications, and in-hospital mortality were evaluated. Results In total, 731 patients were treated with blunt hepatic and/or splenic injuries. Among these, 368 had a liver injury, 280 splenic injury, and 83 combined hepatic/splenic injury. Initial NOM was performed in 82.6% of all patients (93.5% in hepatic and 71.8% in splenic injuries) with a success rate of 96.7%. The secondary failure rate of NOM was 3.3% and remained consistent over 17 years ( p = 0.515). In terms of injury severity, we observed a reduction over time, resulting in an overall mortality rate of 4.8% and 3.5% in the NOM group (decreasing from 7.5 to 1.9% and from 5.6 to 1.3%, respectively). These outcomes confirmed an improved utilization of the NOM approach. Conclusion Our cohort represents one of the largest Central European single-center experiences available in the literature. NOM is the standard of care for blunt hepatic and splenic injuries and successful in > 96% of all patients. This rate was quite constant over 17 years ( p = 0.515). Overall, national and regional safety measures resulted in a significantly decreased severity of observed injury patterns and deaths due to blunt hepatic or splenic trauma. Although surgery is nowadays only applied in about one third of splenic injury patients in our center, these numbers might further decrease by intensified application of interventional radiology and modern coagulation management. Electronic supplementary material The online version of this article (10.1186/s13017-019-0249-y) contains supplementary material, which is available to authorized users.

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Section: Discussionmentioning

confidence: 99%

Non-operative management of blunt hepatic and splenic injury: a time-trend and outcome analysis over a period of 17 years

et al. 2019

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“…Several topics related to the follow-up of these patients are still controversial. These include the frequency of clinical reevaluations and laboratory tests, the duration of patient monitoring, transfusion thresholds that would indicate intervention (surgery or angiography), time to iniciate venous thromboembolism (VTE) prophylaxis, the time of bed rest and hospital stay, the need for immunization after spleen embolization and after extensive splenic injury submitted to NOM, the indication of control imaging and outpatient follow-up after hospital discharge 5 , 7 , 18 .…”

Section: Introductionmentioning

confidence: 99%

“…As with non-operative treatment of other abdominal organs, there is some concern in initiating prophylaxis due to the risk of rebleeding and failure of NOM 51 . However, studies have shown that it is safe to introduce VTE chemoprophylaxis within the first 48h-72h of hospital admission 18 , 49 , 51 , 52 without increasing the incidence of failure of NOM 52 . Joseph et al 49 observed a tendency towards a higher incidence of thromboembolic complications in patients receiving late prophylaxis (after 72h), although this difference was not statistically significant.…”

Section: Introductionmentioning

confidence: 99%

“…There is no consensus in the literature about this value. Fodor et al indicates that transfusion of 2 or more red blood cell concentrates should already be indicative of failure of NOM 18 . In this case, NOM should only be continued if the cause of the need for transfusion is related to other lesions; however, this decision is based on clinical judgment, as in practice it is difficult to establish the cause of the need for transfusion when there is more than one possible focus of bleeding.…”

Section: Introductionmentioning

confidence: 99%

“…One study showed that pseudoaneurysms can appear even in grade II and III 55 injuries on a control tomography between 1 and 8 days of trauma in 15% of the cases, half of which evolved with spontaneous pseudoaneurysm occlusion, without the need of any intervention. As such, repeat imaging appears to be an unnecessary practice because it did not influence the treatment 18 . However, it is noteworthy that data regarding the long term evolution of these patients are lacking, especially regarding the need for angioembolization of the lesions identified in the control CT 56 , 57 .…”

Section: Introductionmentioning

confidence: 99%

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Non-operative management of blunt splenic trauma: evolution, results and controversies

Júnior

Menegozzo

Rocha

et al. 2021

Rev. Col. Bras. Cir.

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The spleen is one of the most frequently affected organs in blunt abdominal trauma. Since Upadhyaya, the treatment of splenic trauma has undergone important changes. Currently, the consensus is that every splenic trauma presenting with hemodynamic stability should be initially treated nonoperatively, provided that the hospital has adequate structure and the patient does not present other conditions that indicate abdominal exploration. However, several topics regarding the nonoperative management (NOM) of splenic trauma are still controversial. Splenic angioembolization is a very useful tool for NOM, but there is no consensus on its precise indications. There is no definition in the literature as to how NOM should be conducted, neither about the periodicity of hematimetric control, the transfusion threshold that defines NOM failure, when to start venous thromboembolism prophylaxis, the need for control imaging, the duration of bed rest, and when it is safe to discharge the patient. The aim of this review is to make a critical analysis of the most recent literature on this topic, exposing the state of the art in the NOM of splenic trauma.

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Severe liver trauma with complex portal and common bile duct avulsion: A case report and review of the literature

Mitricof¹,

Kraft²,

Antón³

et al. 2023

World J Clin Cases

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BACKGROUND Given its size and location, the liver is the third most injured organ by abdominal trauma. Thanks to recent advances, it is unanimously accepted that the non-operative management is the current mainstay of treatment for hemodynamically stable patients. However, those patients with hemodynamic instability that generally present with severe liver trauma associated with major vascular lesions will require surgical management. Moreover, an associated injury of the main bile ducts makes surgery compulsory even in the case of hemodynamic stability, thereby imposing therapeutic challenges in the tertiary referral hepato-bilio-pancreatic centers’ setting. CASE SUMMARY We present the case of a 38-year-old male patient with The American Association for the Surgery of Trauma grade V liver injury and an associated right branch of portal vein and common bile duct avulsion, due to a crush polytrauma. The patient was referred to the nearest emergency hospital and because of the hemorrhagic shock, damage control surgery was performed by means of ligation of the right portal vein branch and right hepatic artery, and hemostatic packing. Afterwards, the patient was referred immediately to our tertiary hepato-bilio-pancreatic center. We performed depacking, a right hepatectomy and Roux-en-Y hepaticojejunostomy. On the 9 th postoperative day, the patient developed a high output anastomotic bile leak that required a redo of the cholangiojejunostomy. The postoperative period was marked by a surgical incision site of incomplete evisceration that was managed non-operatively by negative wound pressure. The follow-up was optimal, with no complications at 55 mo. CONCLUSION In conclusion, the current case clearly supports that a favorable outcome in severe liver trauma with associated vascular and biliary injuries is achieved thru proper therapeutic management, conducted in a tertiary referral hepato-bilio-pancreatic center, where a stepwise and complex surgical approach is mandatory.

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Management of blunt hepatic and splenic trauma in Austria: a national questionnaire study

Cited by 4 publications

References 33 publications

Non-operative management of blunt hepatic and splenic injury: a time-trend and outcome analysis over a period of 17 years

Non-operative management of blunt hepatic and splenic injury: a time-trend and outcome analysis over a period of 17 years

Non-operative management of blunt splenic trauma: evolution, results and controversies

Severe liver trauma with complex portal and common bile duct avulsion: A case report and review of the literature

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