Nonoperative Management of Blunt Hepatic Trauma Is the Treatment of Choice for Hemodynamically Stable Patients Results of a Prospective Trial

Croce, Martin A.; Fabian, Timothy C.; Menke, P G; Waddle-Smith, Lynda; Minard, Gayle; Kudsk, Kenneth A.; Patton, Joe H.; Schurr, Michael J.; Pritchard, F E

doi:10.1097/00000658-199506000-00013

Cited by 436 publications

(323 citation statements)

References 23 publications

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“…The abdomen is often injured by both penetrating and blunt trauma and the liver, due to its size and anatomical location, is frequently affected [1][2][3] . Hepatic trauma corresponds to approximately 5% of admissions to emergency rooms 2,4 . In recent years, the diagnosis and treatment of hepatic trauma has evolved with the use of computerized tomography (CT), and the likelihood of non-operative management for selected hemodynamically stable patients has become a reality in many trauma centers worldwide.…”

Section: Introduction Introduction Introduction Introduction Introducmentioning

confidence: 99%

Trauma hepático: uma experiência de 21 anos

Zago

Pereira

Nascimento

et al. 2013

Rev. Col. Bras. Cir.

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OBJETIVO: avaliar os aspectos epidemiológicos, conduta, morbidade e resultados do tratamento trauma hepático. MÉTODOS: estudo retrospectivo de doentes com mais de 13 anos de idade admitidos em um hospital universitário de 1990 a 2010, submetidos ao tratamento cirúrgico ou não operatório (TNO). RESULTADOS: foram admitidos 748 pacientes com trauma hepático. O mecanismo de trauma mais frequente foi o trauma penetrante (461 casos; 61,6%). O trauma fechado ocorreu em 287 pacientes (38,4%). De acordo com o grau de lesão hepática (AAST-OIS), no trauma fechado foi observada uma predominância dos graus I e II e no trauma penetrante, uma predominância do grau III. O TNO foi realizado em 25,7% dos pacientes com trauma hepático contuso. Entre os procedimentos cirúrgicos, a sutura foi realizada com maior frequência (41,2%). A morbidade relacionada ao fígado foi 16,7%. A taxa de sobrevida para pacientes com trauma hepático fechado foi 73,5% e no trauma penetrante de 84,2%. A mortalidade no trauma complexo foi 45,9%. CONCLUSÃO: o trauma permanece mais incidente nas populações mais jovens e no sexo masculino. Houve uma redução dos traumas hepáticos penetrantes. O TNO se mostrou seguro e efetivo, e, frequentemente, foi empregado para tratar os pacientes com trauma hepático penetrante. A morbidade foi elevada e a mortalidade foi maior em vítimas de traumas contusos e em lesões hepáticas complexas.

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Section: Introduction Introduction Introduction Introduction Introducmentioning

confidence: 99%

Trauma hepático: uma experiência de 21 anos

Zago

Pereira

Nascimento

et al. 2013

Rev. Col. Bras. Cir.

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“…The incidence of liver injury in our study is higher as compared to reported incidence of liver injury in literature. Croce et al [2] reported 5 % incidence of liver injury while Malhotra et al [3] had reported 4.6 % incidence of liver injury.…”

Section: Discussionmentioning

confidence: 98%

“…Recent series of NOM has demonstrated that it is safe and effective in selected patients with both blunt and penetrating abdominal trauma with variable success rate ranging between 83 and 97 % [2][3][4]7]. Petrowsky et al [4] had shown 96 % success rate of NOM with 2.2 % liver-specific failure rate of NOM.…”

Section: Discussionmentioning

confidence: 99%

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Retrospective Evaluation of Magnitude, Severity and Outcome of Traumatic Hepatobiliary Injury at a Level-I Trauma Center in India

et al. 2015

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Liver injury is the major cause of morbidity and mortality in polytrauma patients. This study was conducted to know the burden of hepatobiliary injury and its outcome in our setup. It is a retrospective study of all patients with traumatic hepatobiliary injuries from January 2008 through April 2012 at JPNATC, New Delhi. All patients were resuscitated as per ATLS guidelines. Management of patients was based on hemodynamic status and associated injuries. Liver injury occurred in 7.52 % of all trauma admissions and 20.34 % of total abdominal trauma patients. Most common mechanism of injury was blunt trauma due to road traffic injury among all age groups (n=234, 67.83 %). Seventy-five percent of the patients with liver injury were hemodynamically stable at presentation (n=262, 75 %). Isolated liver injury was seen in 27 % of the patients. Grade II (n=138, 40 %) liver injury was the most common. Of the patients, 68.70 % were managed nonoperatively. Among operatively managed patients (n=100, 29 %), 38 % patient underwent immediate laparotomy due to hemodynamic instability. The failure of nonoperative management was in eight (2.32 %) patients with success rate of 96.73 %, i.e., 237 patients out of 245 were successfully managed nonoperatively. Packing was done in 27 % of the patients of high-grade liver injury and was associated with high morbidity and mortality (51 %). The morbidity and mortality of liver trauma were 28.99 % and 12.17 %, respectively. Liver injury is common in abdominal trauma patients. Most of the patients with liver injury are hemodynamically stable and should be managed nonoperatively with careful monitoring.

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“…Bolesnici sa povredama jetre čine oko 5% svih politraumatizovanih [4], a oko 35% ovih povreda je prisutno u abdominalnoj traumi. Na povrede jetre treba pomisliti kod svih bolesnika sa tupom ili penetrantnom torakoabdominalnom traumom, posebno kod onih u stanju šoka sa povredama na desnoj strani tijela.…”

Section: Uvodunclassified

Izbor optimalne operativne procedure u liječenju povreda jetre

Krivokuća¹,

Mavija²,

Golić

et al. 2016

Biomedicinska istraž.

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Kratak sadržajUvod. Jetra je najčešće povređivan organ u traumi. Zahvaljujući unapređen-ju strategije liječenja, mortalitet kod povreda jetre je posljednjih decenija u značajnom padu. Cilj rada je da prikaže koliko su povrede jetre kompleksan problem koji zahtijeva multidisciplinarni pristup u dijagnostici i liječenju, a ciljevi hirurškog liječenja su kontrola krvarenja, očuvanje funkcije jetre i prevencija komplikacija.Metode. Retrospektivnom studijom je obuhvaćeno 98 bolesnika operisanih zbog povreda jetre na Klinici za Opštu i abdominalnu hirurgiju UKC Banja Luka u periodu 2006-2016. Iz istorije bolesti su analizirani: epidemiološki podaci, mehanizam nastanka traume, dijagnostički pristup, stepen povrede jetre, ukupna težina traume, učinjene hirurške procedure, ishod liječenja i komplikacije.Rezultati. Od 288 bolesnika koji su operisani zbog teške abdominalne traume, 98 je imalo povredu jetre (33 izolovane povrede jetre, a 55 udružene povrede jetre i nekog od abdominalnih organa). Tretman teških povreda jetre uključivao je perihepatično pakovanje kod 12, suturu jetre kod 71 i neki od tipova resekcije jetre kod 5 bolesnika. Kod 10 bolesnika učinjena je samo hirurška eksploracija i drenaža trbušne duplje. Od 74 bolesnika, kod kojih je uzrok povrede bila tupa trauma, umrlo je 19 (25,68%), dok su od 24 bolesnika sa ubodnom i sklopetarnim povredama umrla dva (8,33%) bolesnika. Mortalitet je bio značajno niži kod pacijenata s povredama I, II i III stepena u odnosu na povrede IV I V stepena (p = 0,015). Četiri (4,08%) bolesnika su imala postoperativnu sepsu, 20 (20,41%) pleuralni izliv, a kod tri (3,06%) bolesnika se razvio akutni respiratorni distress sindrom (ARDS).Zaključak. Ukupni mortalitet od 21,4% u našoj studiji je bio usko povezan sa stepenom težine povrede jetre, a značajno je smanjen zahvaljujući savremenim dijagnostičkim i terapijskim metodama.

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Nonoperative Management of Blunt Hepatic Trauma Is the Treatment of Choice for Hemodynamically Stable Patients Results of a Prospective Trial

Cited by 436 publications

References 23 publications

Trauma hepático: uma experiência de 21 anos

Trauma hepático: uma experiência de 21 anos

Retrospective Evaluation of Magnitude, Severity and Outcome of Traumatic Hepatobiliary Injury at a Level-I Trauma Center in India

Izbor optimalne operativne procedure u liječenju povreda jetre

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