Selective nonoperative management of liver gunshot injuries

Navsaria, Pradeep; Nicol, Andrew; Edu, Sorin; Chowdhury, Sharfuddin

doi:10.1007/s00068-018-0913-z

Cited by 33 publications

(27 citation statements)

References 26 publications

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“…In PT, NOM feasibility has been reported [35][36][37][45][46][47][48][49] with 50% and 85% success rate of NOM for stab wounds (SW) in anterior and posterior abdomen respectively [34,50]. Similar managing strategy can be applied to GSWs [35,45]. Necessary distinction between low-and high-energy penetrating trauma however is mandatory when deciding for OM or NOM.…”

Section: Diagnosismentioning

confidence: 99%

“…In abdominal GSWs, up to 25% of non-therapeutic laparotomy has been reported [51], confirming the need to have strict selection criteria for OM or NOM even in the GSW cohort. Associated head and spinal cord injuries (that preclude affordable clinical examination) and significant reduction in hemoglobin requiring > 4 units of blood transfusion in the first 8 h [34,45] have been suggested as predictive criteria of NOM failure in abdominal GSWs.…”

Section: Diagnosismentioning

confidence: 99%

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Liver trauma: WSES 2020 guidelines

et al. 2020

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Liver injuries represent one of the most frequent life-threatening injuries in trauma patients. In determining the optimal management strategy, the anatomic injury, the hemodynamic status, and the associated injuries should be taken into consideration. Liver trauma approach may require non-operative or operative management with the intent to restore the homeostasis and the normal physiology. The management of liver trauma should be multidisciplinary including trauma surgeons, interventional radiologists, and emergency and ICU physicians. The aim of this paper is to present the World Society of Emergency Surgery (WSES) liver trauma management guidelines.

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Section: Diagnosismentioning

confidence: 99%

Section: Diagnosismentioning

confidence: 99%

Liver trauma: WSES 2020 guidelines

et al. 2020

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“…64 Several studies have demonstrated the efficacy and positive outcomes (69-100% of cases) of NOM in penetrating hepatic injury, even for grade III-IV injuries that required angioembolization (AE). 59,[65][66][67][68][69][70][71][72] Serial abdominal exams and contrast-enhanced CT are crucial to help guide the appropriate management of these patients. 59 Hemodynamic stability, lack of peritoneal signs, and lack of significant visceral abdominal injuries are indicators for NOM.…”

Section: Magnetic Resonance Imagingmentioning

confidence: 99%

Management of Hepatic Trauma: An Update

Lang

Dahan

et al. 2018

Dig Dis Interv

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Being the largest solid abdominal organ, the liver is the second most commonly injured organ after abdominal trauma. In this review, we discuss the American Association for the Surgery of Trauma's (AAST) liver injury grading system and World Society of Emergency Surgery's triage grading system. Furthermore, we discuss the role of imaging in hepatic trauma, as well as the indications, techniques, and roles of nonoperative and operative management.

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“…Firearm injuries represent the sixth leading mechanism of injury managed by the Cape Town trauma system, Cape Town, South Africa (1)(2)(3)(4)(5)(6)(7)(8). The mortality rate associated with abdominal gunshot wounds (GSWs) remains high with many deaths occurring as a result of exsanguination and irreversible shock (9)(10)(11)(12).…”

Section: Introductionmentioning

confidence: 99%

Indications, mortality, and long-term outcomes of 50 consecutive patients undergoing damage control laparotomy for abdominal gunshot wounds

et al. 2019

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Introduction:Outcomes of patients undergoing damage control laparotomy (DCL) for abdominal gunshot wounds (GSWs) remains relatively unknown. The purpose of this study was to evaluate the impact of DCL on long term morbidity and survival.Methods: This retrospective study was conducted on patients undergoing a damage control laparotomy for abdominal GSWs. The data were collected using 50 consecutive trauma patients over a 4.5-year-period between August 1 st , 2004 and September 30 th , 2009. The patients were classified regarding the characteristics, such as age, perioperative physiological parameters, trauma indices, number of abdominal GSWs, critical care unit stay, hospital length of stay, morbidity, and mortality. Univariate and multivariate logistic regression was employed to compute the odds of survival and estimate the unadjusted and adjusted association between these factors.Results: According to the results, the majority of the patients were male (96%) with a mean age of 29.7 years who had a single abdominal gunshot wound (60%). Liver injuries (58%) followed by small bowel (44%), majors venous (40%), and colonic (38%) trauma were observed in the patients. The overall mortality rate was obtained at 54%. The mean length of intensive care unit stay and mean hospital length of stay were 7 and 13 days, respectively. Factors associated with a decreased odds of survival included Penetrating Abdominal Trauma Index (PATI) > 25, intra-operative blood lactate level > 8 mmol/L, and massive transfusion >10 units packed red blood cells. Conclusions:After controlling the confounding factors, a PATI score of > 25 was associated with a decreased odds of survival (OR: 0.20, P=0.04).

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Selective nonoperative management of liver gunshot injuries

Abstract: The NOM of carefully selected patients with GLI is safe and associated with minimal morbidity.

Cited by 33 publications

References 26 publications

Liver trauma: WSES 2020 guidelines

Liver trauma: WSES 2020 guidelines

Management of Hepatic Trauma: An Update

Indications, mortality, and long-term outcomes of 50 consecutive patients undergoing damage control laparotomy for abdominal gunshot wounds

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