Selective Nonoperative Management of Penetrating Abdominal Solid Organ Injuries

Δημητριάδης, Δημήτριος; Hadjizacharia, Pantelis; Constantinou, Costas S.; Brown, Carlos; Inaba, Kenji; Rhee, Peter; Salim, Ali

doi:10.1097/01.sla.0000237743.22633.01

Cited by 169 publications

(266 citation statements)

References 33 publications

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“…NOM failure increased length of hospital stay and increased mortality in selected subsets of patients (9,32). Accordingly, NOM has shorter length of hospital stay than operative management in patients with isolated solid organ injuries (30). In contrast, the length of hospital stay of NOM group was shorter in this study.…”

Section: Discussioncontrasting

confidence: 50%

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Independent Risk Factors for Failure of Nonoperative Management in Patients with Splenic Injury

et al. 2015

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Section: Discussioncontrasting

confidence: 50%

“…In addition to blunt trauma, NOM also can be applied for penetrating traumas. Dematriades et al (30) applied it liver in 28.4% of selected patients, kidney in 14.9%, and spleen in 3.5%. In our study, seventy-one patients who suffered from blunt and, six from low-grade penetrating injuries were treated non-operatively.…”

Section: Discussionmentioning

confidence: 99%

Independent Risk Factors for Failure of Nonoperative Management in Patients with Splenic Injury

et al. 2015

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“…A study performed on 152 patients with penetrating liver trauma revealed that 125 patients (82.2 %) were operated upon due to hemodynamically instability and 27 patients (17.8 %) were treated with NOM due to hemodynamic stability. All these patients were evaluated with serial physical examination and CT scan [15]. These studies support the fact that NOM of the selected cases of penetrating liver trauma is safe especially if the patient was hemodynamically stable.…”

Section: Discussionmentioning

confidence: 58%

Management of Liver Trauma in Minia University Hospital, Egypt

2015

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The aim of this study is to present the outcome of operative and non-operative management of patients with liver injury treated in a single institution depending on imaging. This study was conducted at the Causality Unit of Minia University Hospital, and included 60 patients with hepatic trauma from March 2012 to January 2013. In our study, males represent 80 % while females represent 20 % of the traumatized patients. The peak age for trauma found was 11-30 years. Blunt trauma is the most common cause of liver injury as it was the cause in 48 patients (80 %). Firearm injuries are the most common cause of penetrating trauma (60 %) followed by stab injuries (40 %). More than one half of our patients (34 out of 60) were treated with non-operative management (NOM) with a high success rate. The operative procedures done were suture hepatorrhaphy (20 cases), non-anatomical resection in one case, anatomical resection in one case, and damage control therapy using pads in two cases. In another two cases, nothing was done as subcapsular hematoma had resolved. Minia University Hospital is a big tertiary Hospital in Egypt at which blunt liver trauma is more common than penetrating liver trauma. Surgery is no longer the only option available. It has been reserved for extensive lesions with condition of hemodynamic instability or for the treatment of the complications. NOM is an effective treatment modality in most cases.

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“…NOM is intended in around 65 % of the blunt liver injury cases with success rates of about 90 % [2•, 17]. For penetrating trauma, NOM is intended in about 30 % of cases with success rates of around 80 % [18,19]. Endovascular interventions are indicated to aid NOM when clinical or imaging findings suggest persistent liver hemorrhage [7].…”

Section: Hepatic Injurymentioning

confidence: 99%

Interventional Radiology: Interventions and Techniques in Trauma

Garza-Berlanga

Lopera

2016

Curr Trauma Rep

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Purpose of Review The purpose of the review was to describe how interventional radiology procedure contribute in the management of the trauma patient, distinguish the situations where evidence has demonstrated improved outcomes with its use, acknowledge the limitations and controversies of the techniques and their place on management algorithms, and mention some particular situations where, despite lack of evidence, the procedures are commonly employed. Recent Findings CT seems to be a better indicator of significant vascular injury with the associated high risks when compared to a discordant negative conventional angiogram. Empiric embolization of the injured segments might improve outcomes in these settings. Finding a subcapsular splenic hematoma in CT is an independent risk factor associated with high rates of NOM failure. Prophylactic interventions are recommended, even in low grade splenic injuries, when a subcapsular splenic hematoma is present. In liver trauma, the injured liver is more susceptible to ischemic injury from arterial embolization with subsequent infarct, biloma, and abscess formation. When needed, angio-embolization should be performed as selective as possible. Subsequent surveillance for ischemic liver injury complications should be instated and, if required, timely therapeutic interventions considered.Summary The initial CT scan findings of Bcontrast blush^and high-grade solid organ injury are some of the best early predictors for failure of the non-operative management (NOM) in the trauma patient. Endovascular interventions improve the outcomes of NOM when clinical or imaging findings indicate a high risk for continued or delayed hemorrhage. Angioembolization improves the outcomes of unstable hemorrhagic pelvic fractures and is useful as complement of damage control surgeries or when the surgical interventions fail to control vascular injuries.

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Selective Nonoperative Management of Penetrating Abdominal Solid Organ Injuries

Abstract: In the appropriate environment, selective nonoperative management of penetrating abdominal solid organ injuries has a high success rate and a low complication rate.

Cited by 169 publications

References 33 publications

Independent Risk Factors for Failure of Nonoperative Management in Patients with Splenic Injury

Independent Risk Factors for Failure of Nonoperative Management in Patients with Splenic Injury

Management of Liver Trauma in Minia University Hospital, Egypt

Interventional Radiology: Interventions and Techniques in Trauma

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