The mythology of hepatic trauma—or babel revisited

Walt, Alexander J.

doi:10.1016/0002-9610(78)90003-x

Cited by 125 publications

(44 citation statements)

References 15 publications

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“…It is difficult to compare this with the rates in other recent studies (6%-35%), as it is not always known whether global mortality, mortality due directly to the hepatic injury or to concomitant lesions, mortality on patient's arrival (35%) [16] before or immediately after the operation [4,10,16,20] is meant. The peculiarity of this series is the specific recruitment from spinal surgery and neurosurgery patients, which explains the high proportion of patients with severe hepatic injuries (classes IV and V: 25%) and concomitant lesions in often severe multisystern traumas (58% of those with blunt traumas).…”

Section: Discussionmentioning

confidence: 83%

“…There is little similarity between a superficial stab wound 336 and lobar tissue destruction resulting form a fall. In addition to concomitant intra-or extraabdominal injuries, the prognosis depends primarily on the severity of the hepatic lesion [4] and how profusely it is bleeding [20]. If primary hemostasis is achieved different procedures ranging from the Pringle maneuver to intracaval shunting may be indicated.…”

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confidence: 99%

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Hepatic trauma: experience with 135 consecutive liver injuries (1982?1989) and arguments for conservative surgery

Chevallier

Jost

Ménégaux

et al. 1991

Langenbecks Arch Chir

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Most hepatic traumas are easily cured, but the series of 135 consecutive hepatic wounds reported in the present paper is unusual in that the patients were specifically recruited from among patients subjected to neurosurgical or spinal operations, 25% of whom sustained severe hepatic injuries (classes IV and V) as a result of the surgery. The postoperative mortality was analyzed according to such potentially predictive factors as severity of the hepatic wound, the concomitant extraabdominal lesions, the initial shock, and the kind of surgical treatment. The statistical comparison of the factors affecting the results was analyzed by the Chi-square test. The postoperative mortality rate was 24.4% (33 deaths). This mortality rate is evidently related to the severity of the hepatic lesions and to the frequent associated lesions. The 14 deaths from benign and moderate hepatic injuries were due to concomitant lesions. Among the 19 deaths from severe lesions, 12 were directly related to the severity of the hepatic injury and 7 to associated wounds. Complications directly related to the hepatic trauma occurred in 39 cases with 16 deaths. In general, conservative surgical treatment can be performed with quite low mortality. Among the patients who require hepatic resection one of two dies of hemorrhage or coagulopathy. Among conservative procedures, perihepatic packing has proved to be efficient and safe. If perioperative cholangiography has excluded any leak from a major bilde duct, septic complications are rare. Therefore, the surgical treatment of hepatic trauma should be as conservative as possible, because this can stop hemorrhage and decrease the risk of coagulopathy.(ABSTRACT TRUNCATED AT 250 WORDS)

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Section: Discussionmentioning

confidence: 83%

mentioning

confidence: 99%

Hepatic trauma: experience with 135 consecutive liver injuries (1982?1989) and arguments for conservative surgery

Chevallier

Jost

Ménégaux

et al. 1991

Langenbecks Arch Chir

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“…In reports from North America 4,6 liver trauma is most frequently due to penetrating injury from knife or gunshot wounds, and blunt abdominal trauma is less common. This is an important distinction as blunt abdominal trauma carries a markedly higher mortality 7 due to the often grosser degree of hepatic damage and the much higher incidence of associated injury to other organs and systems.…”

Section: Discussionmentioning

confidence: 99%

“…Biliary drainage via a T-tube is indicated only in damage to the extrahepatic bile ducts 4 and was not required in this series. When brisk bleeding from deep lacerations was encountered, the portal triad was occluded by a vascular clamp (Pringle's maneuver) 5 to gain temporary control and to facilitate accurate determination of the source of hemorrhage.…”

Section: Methodsmentioning

confidence: 98%

Patterns and Management of Liver Trauma in Riyadh Central Hospital

Al-Kraida

1988

Ann Saudi Med

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A retrospective study is presented of all patients undergoing laparotomy for liver trauma during a one-year period at the Riyadh Central Hospital. The total number of patients was 38, the majority (36) were men between 21 and 30 years old. Blunt abdominal trauma from road traffic accidents was the predominant cause in 36 patients (95%), and two patients (5%) suffered penetrating injury from gunshot wounds. Associated injury of other organs or systems frequently accompanied the blunt abdominal trauma and was responsible for mortality in four patients. Three patients with extensive liver damage as well as juxtahepatic injury to the hepatic veins or inferior vena cava died from major hemorrhage. The overall mortality was 18.4%. The majority of liver injuries can be managed surgically by simple suture techniques. A scheme for the surgical management of liver trauma is outlined.AA Al-Kraida, Patterns and Management of Liver Trauma in Riyadh Central Hospital. 1988; 8(1): 25-28 MeSH

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“…As Dr Walt said in his address before the Society for Surgery of the Alimentary Tract: "Too much has been written on the topic of hepatic venous injuries and there are possibly more authors on the subject than survivors of the procedures described" (25). Vascular isolation and intemal shunting have both been practised with limited success, with continuing controversy over which is the optimal approach.…”

Section: Discussionmentioning

confidence: 99%

8.4 Penetrating injuries of the abdominal inferior vena cava

Benn¹

1997

Cardiovascular Surgery

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The mythology of hepatic trauma—or babel revisited

Cited by 125 publications

References 15 publications

Hepatic trauma: experience with 135 consecutive liver injuries (1982?1989) and arguments for conservative surgery

Hepatic trauma: experience with 135 consecutive liver injuries (1982?1989) and arguments for conservative surgery

Patterns and Management of Liver Trauma in Riyadh Central Hospital

8.4 Penetrating injuries of the abdominal inferior vena cava

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