Nonoperative management of penetrating liver trauma

Pal, Khawaja Muhammad Inam; Khan, Adeel Ahmed

doi:10.1016/s0020-1383(99)00184-9

Cited by 8 publications

(16 citation statements)

References 6 publications

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“…However, during surgery, or manipulation of the injury, massive bleeding may occur due to loss of the clot. This bleeding is often difficult to control, requiring complex surgical maneuvers, and is associated with high morbidity 26 . In some circumstances of heavy bleeding in critical injuries, it is not possible toachieve satisfactory hemostatic results using conventional surgical techniques, so damage control surgery maneuvers are required instead.…”

Section: Results Results Results Resultsmentioning

confidence: 99%

“…A laparotomy, in most cases, is still the safest approach. However, in a highly selective group of patients, NOM may be a feasible option for this type of injury, being safe and demonstrating high success rates 8,26,[28][29][30] . The most difficult and important aspect, no doubt, is the selection and appropriate monitoring of the patients.…”

Section: Results Results Results Resultsmentioning

confidence: 99%

“…They show an incidence of complications that varies from 3.8% to 50%, the less frequent being directly related to the liver injuries. The success rates varied from 68.5% to 100% 26,[28][29][30] . Although severe injuries are associated with increased complication rates, the grades of injury, per se, are not shown to be an independent factor for NOM failure, justifying its performance even for injuries considered complex, i.e.…”

Section: Results Results Results Resultsmentioning

confidence: 99%

“…Although severe injuries are associated with increased complication rates, the grades of injury, per se, are not shown to be an independent factor for NOM failure, justifying its performance even for injuries considered complex, i.e. for grade IV and V injuries 26,30 . The presence of contrast blush on a CT, which means to the presence of vascular injury, a pseudoaneurysm or arteriovenous fistula, is a factor that predisposes NOM failure.…”

Section: Results Results Results Resultsmentioning

confidence: 99%

“…Most of these complications (bilioma, biliary fistula, infected hematoma, bilhemia, among others) can be treated with minimally invasive methods such as endoscopic retrograde cholangiopancreatography (for papillotomy and the insertion of stents), puncture and drainage of collections guided by ultrasound or videolaparoscopy. However, the most frequent complications are related to associated injuries, particularly thoracic (retained hemothorax, empyema, infected pulmonary contusion) and, sometimes, to renal injuries 8,26,[28][29][30] . This higher frequency of subsequent complications to associated injuries explains, at least partially, the low rate of complications found (3.8%) in this study.…”

Section: Results Results Results Resultsmentioning

confidence: 99%

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Isolated liver gunshot injuries: nonoperative management is feasible?

Starling

Azevedo

Santana

et al. 2015

Rev. Col. Bras. Cir.

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Objective:to evaluate the safety and effectiveness of non-operative management (NOM) of liver injury, being the only abdominal injury, from gunshot wounds to the abdomen.Methods:patients who had liver damage diagnosed as single abdominal injury caused by PAF in the right thoracoabdominal region, hemodynamically stable were studied. All underwent examination with computed tomography. Were analyzed: age, gender, levels of trauma, hemodynamic condition and the abdominal examination on admission, the results of the CT scan, the extra-abdominal lesions found, the serum levels of hemoglobin, clinical course, complications, length of hospital stay, outpatient treatment and death.Results:during the study period 169 patients, treated non-operatively, presented liver gunshot wounds. Of these, only 28 patients (16.6%) had liver injury as the only abdominal injury and consequently met the inclusion criteria for this study. The average age was 27.7 years and 25 patients (89.2%) were male. The overall average of verified trauma scores were: RTS 7.45, ISS 10.9, and TRISS 98.7%. The most frequent injuries were grade II and grade III (85.7%). Complications occurred in only one patient who presented a progressive decline in hemoglobin. He underwent a CT scan which showed blush in the liver parenchyma. An arteriography was performed, which showed a successfully embolized arteriovenous fistula. There were no deaths in the patient sample. The average hospital stay was 5.3 days.Conclusion:isolated hepatic injury in gunshot abdominal trauma is uncommon. However, the NOM protocol for this type of injury is safe and has low morbidity. This approach should only be followed in institutions with adequate infrastructure, where an experienced and cohesive team is able to follow a specific protocol, with rigorous periodic evaluation of its results.

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Section: Results Results Results Resultsmentioning

confidence: 99%