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Gallaher J, Burton V, Schneider AB, Reid T, Raff L, Smith CB, Charles A. The Effect of Angioembolization Versus Open Exploration for Moderate to Severe Blunt Liver Injuries on Mortality. World J Surg 2023; 47:1271-1281. [PMID: 36705742 DOI: 10.1007/s00268-023-06926-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/11/2023] [Indexed: 01/28/2023]
Abstract
INTRODUCTION Blunt liver injury is common and is associated with a high morbidity and mortality. More severe injuries often require either angioembolization or open operative repair, depending on patient factors and facility capacity. We sought to describe patient outcomes based on intervention type. METHODS We analyzed the National Trauma Data Bank (2017-2019) using ICD-10 codes to identify adult patients with blunt liver injury and their interventions. AIS (Abbreviated Injury Scale) scores were used to group patients based on liver injury severity (AIS 2-6). Logistic regression modeling was used to estimate the adjusted odds ratio of death based on intervention type, excluding patients with severe injury. RESULTS Of 2,848,592 trauma patients, 50,250 patients had a blunt liver injury. Among patients with AIS 3/4/5 injury, 1,140 had angioembolization, 1,529 had an open repair, and 188 had both angioembolization and open repair. In comparison with no intervention and adjusted for age, sex, shock index, ISS, and transfusion total (first four hours), angioembolization was associated with a significant decrease in the odds of mortality for patients with an AIS 4 (OR 0.68, 95% CI 0.47, 0.99) and AIS 5 injury (OR 0.39, 95% CI 0.24, 0.64). In patients with an AIS 5 injury, open repair had an increased odds of mortality at OR 1.99 (95% CI 1.47, 2.69). CONCLUSION In an analysis of a national trauma database, patients with a moderate to severe injury (AIS 4 or 5), angioembolization was associated with a significant reduction in the adjusted odds of mortality compared to open repair and should be considered when clinically appropriate.
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Affiliation(s)
- Jared Gallaher
- Division of Trauma and Acute Care Surgery, Department of Surgery, University of North Carolina at Chapel Hill, 4006 Burnett Womack Building, Chapel Hill, NC, 27599-7228, USA.
| | - Victoria Burton
- Division of Trauma and Acute Care Surgery, Department of Surgery, University of North Carolina at Chapel Hill, 4006 Burnett Womack Building, Chapel Hill, NC, 27599-7228, USA
| | - Andrew B Schneider
- Division of Trauma and Acute Care Surgery, Department of Surgery, University of North Carolina at Chapel Hill, 4006 Burnett Womack Building, Chapel Hill, NC, 27599-7228, USA
| | - Trista Reid
- Division of Trauma and Acute Care Surgery, Department of Surgery, University of North Carolina at Chapel Hill, 4006 Burnett Womack Building, Chapel Hill, NC, 27599-7228, USA
| | - Lauren Raff
- Division of Trauma and Acute Care Surgery, Department of Surgery, University of North Carolina at Chapel Hill, 4006 Burnett Womack Building, Chapel Hill, NC, 27599-7228, USA
| | - Charlotte B Smith
- Division of Trauma and Acute Care Surgery, Department of Surgery, University of North Carolina at Chapel Hill, 4006 Burnett Womack Building, Chapel Hill, NC, 27599-7228, USA
| | - Anthony Charles
- Division of Trauma and Acute Care Surgery, Department of Surgery, University of North Carolina at Chapel Hill, 4006 Burnett Womack Building, Chapel Hill, NC, 27599-7228, USA
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Chen YJ, Shen CJ, Yu SH, Lin CL, Shih HM. Increased risk of hepatocellular carcinoma in patients with traumatic liver injury: Real-world data from a nationwide population-based study. Medicine (Baltimore) 2022; 101:e28837. [PMID: 35147128 PMCID: PMC8830875 DOI: 10.1097/md.0000000000028837] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/07/2021] [Accepted: 01/27/2022] [Indexed: 01/04/2023] Open
Abstract
Hepatocellular carcinoma (HCC) is the sixth most common cancer globally, and liver is one of the most commonly injured organs after blunt abdominal trauma. The traumatic liver injury-HCC risk relationship remains unclear.We extracted data of patients with traumatic liver injury between 2000 and 2013 from Taiwan National Health Insurance Research Database (n = 15,966) and those of age-, gender-, occupation-, and index year-matched individuals without traumatic liver injury from the general population (n = 63,864). Cox proportional hazard models were employed to determine the hazard ratios (HRs) and 95% confidence intervals (CIs) for HCC occurrence in the traumatic liver injury cohort compared with that in the comparison cohort.Patients with traumatic liver injury had an increased HCC risk (adjusted HR 2.13, 95% CI 1.59-2.85); this increased risk was more pronounced within 1 year after injury (adjusted HR 8.84, 95% CI 4.29-18.2). After >1 year of injury, HCC risk remained 1.53-fold higher in patients with traumatic liver injury than in those without traumatic liver injury (95% CI 1.08-2.15).People with traumatic liver injury demonstrate a high HCC risk, particularly within the first year of the injury.
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Affiliation(s)
- Yen-Ju Chen
- College of Medicine, China Medical University, Taichung, Taiwan
- Department of Emergency Medicine, China Medical University Hospital, Taichung, Taiwan
| | - Chih-Jung Shen
- College of Medicine, China Medical University, Taichung, Taiwan
- Department of Emergency Medicine, China Medical University Hospital, Taichung, Taiwan
| | - Shao-Hua Yu
- College of Medicine, China Medical University, Taichung, Taiwan
- Graduate Institute of Biomedical Sciences, China Medical University, Taichung, Taiwan
| | - Cheng-Li Lin
- Management Office for Health Data, Clinical Trial Center, China Medical University Hospital, Taichung, Taiwan
| | - Hong-Mo Shih
- College of Medicine, China Medical University, Taichung, Taiwan
- Department of Emergency Medicine, China Medical University Hospital, Taichung, Taiwan
- Department of Public Health, China Medical University, Taichung, Taiwan
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3
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Hu W, Xu Z, Shen X, Gu Y, Dai Z, Chen J, Zhu Z, Zhou Y, Zhao W, Chen C. Accident-related hepatic trauma in a medical clinical center in eastern China: a cross-sectional study. BMC Surg 2021; 21:16. [PMID: 33407367 PMCID: PMC7789588 DOI: 10.1186/s12893-020-01043-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2020] [Accepted: 12/28/2020] [Indexed: 11/11/2022] Open
Abstract
Background The treatment of hepatic injury can be complex. Medical clinical centers are often the first line hospitals for the diagnosis and treatment of hepatic trauma in China. The aim of the study is to summarize the experience in the diagnosis and treatment of hepatic trauma in one medical clinical center in China. Methods This retrospective study included patients with hepatic trauma admitted between January 2002 and December 2019 at the Xishan People’s Hospital of Wuxi. The outcomes were cure rate and death within 14 days post-discharge. Results Among the 318 patients with hepatic trauma, 146 patients underwent surgical treatment, and 172 received conservative treatment; three patients were transferred to other hospitals for further treatment; 283 patients were cured, and 35 died. Severe hepatic trauma occurred in 74 patients, with a mortality rate of 31.1% and accounting for 65.7% of total mortality. American Association for the Surgery of Trauma (AAST) grading ≥ III (OR = 3.51, 95%CI: 1.32–9.37, P = 0.012) and multiple organ injury (OR = 7.51, 95%CI: 2.51–22.46, P < 0.001) were independently associated with death. Among patients with AAST grading ≥ III, surgery was an independent protective factor for death (OR = 0.08, 95%CI: 0.01–0.45, P = 0.004). Among patients with ASST ≥ III and who underwent surgery, age (OR = 5.29, 95%CI: 1.37–20.33, P = 0.015) and peri-hepatic packing (PHP) (OR = 5.54, 95%CI: 1.43–21.487, P = 0.013) were independently associated with death. Conclusions AAST grading ≥ III and multiple organ injury were independently associated with death. Among patients with AAST grading ≥ III, surgery was an independent protective factor for death. Among patients with ASST ≥ III and who underwent surgery, age and PHP were independently associated with death.
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Affiliation(s)
- Weidong Hu
- Department of General Surgery, Wuxi Xishan People's Hospital, Wuxi, No. 1128, Da-Cheng Road, Wuxi, 214105, Jiangsu, China
| | - Zipeng Xu
- Department of General Surgery, Wuxi Xishan People's Hospital, Wuxi, No. 1128, Da-Cheng Road, Wuxi, 214105, Jiangsu, China
| | - Xu Shen
- Department of General Surgery, Wuxi Xishan People's Hospital, Wuxi, No. 1128, Da-Cheng Road, Wuxi, 214105, Jiangsu, China
| | - Yanyan Gu
- Department of General Surgery, Wuxi Xishan People's Hospital, Wuxi, No. 1128, Da-Cheng Road, Wuxi, 214105, Jiangsu, China
| | - Zhengxing Dai
- Department of General Surgery, Wuxi Xishan People's Hospital, Wuxi, No. 1128, Da-Cheng Road, Wuxi, 214105, Jiangsu, China
| | - Jie Chen
- Department of General Surgery, Wuxi Xishan People's Hospital, Wuxi, No. 1128, Da-Cheng Road, Wuxi, 214105, Jiangsu, China
| | - Zhenghai Zhu
- Department of General Surgery, Wuxi Xishan People's Hospital, Wuxi, No. 1128, Da-Cheng Road, Wuxi, 214105, Jiangsu, China
| | - Ying Zhou
- Department of General Surgery, Wuxi Xishan People's Hospital, Wuxi, No. 1128, Da-Cheng Road, Wuxi, 214105, Jiangsu, China
| | - Wanwen Zhao
- Department of General Surgery, Wuxi Xishan People's Hospital, Wuxi, No. 1128, Da-Cheng Road, Wuxi, 214105, Jiangsu, China
| | - Chaobo Chen
- Department of General Surgery, Wuxi Xishan People's Hospital, Wuxi, No. 1128, Da-Cheng Road, Wuxi, 214105, Jiangsu, China. .,Department of Immunology, Ophthalmology and ORL, Complutense University School of Medicine, 28040, Madrid, Spain.
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4
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Ordoñez CA, Parra MW, Millán M, Caicedo Y, Guzmán-Rodríguez M, Padilla N, Salamea-Molina JC, García A, González-Hadad A, Pino LF, Herrera MA, Rodríguez-Holguín F, Serna JJ, Salcedo A, Aristizábal G, Orlas C, Ferrada R, Scalea T, Ivatury R. Damage Control in Penetrating Liver Trauma: Fear of the Unknown. COLOMBIA MEDICA (CALI, COLOMBIA) 2020; 51:e4134365. [PMID: 33795903 PMCID: PMC7968427 DOI: 10.25100/cm.v51i4.4422.4365] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
The liver is the most commonly affected solid organ in cases of abdominal trauma. Management of penetrating liver trauma is a challenge for surgeons but with the introduction of the concept of damage control surgery accompanied by significant technological advancements in radiologic imaging and endovascular techniques, the focus on treatment has changed significantly. The use of immediately accessible computed tomography as an integral tool for trauma evaluations for the precise staging of liver trauma has significantly increased the incidence of conservative non-operative management in hemodynamically stable trauma victims with liver injuries. However, complex liver injuries accompanied by hemodynamic instability are still associated with high mortality rates due to ongoing hemorrhage. The aim of this article is to perform an extensive review of the literature and to propose a management algorithm for hemodynamically unstable patients with penetrating liver injury, via an expert consensus. It is important to establish a multidisciplinary approach towards the management of patients with penetrating liver trauma and hemodynamic instability. The appropriate triage of these patients, the early activation of an institutional massive transfusion protocol, and the early control of hemorrhage are essential landmarks in lowering the overall mortality of these severely injured patients. To fear is to fear the unknown, and with the management algorithm proposed in this manuscript, we aim to shed light on the unknown regarding the management of the patient with a severely injured liver.
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Affiliation(s)
- Carlos A Ordoñez
- Fundación Valle del Lili, Department of Surgery, Division of Trauma and Acute Care Surgery, Cali, Colombia.,Universidad del Valle, Facultad de Salud, Escuela de Medicina, Division of Trauma and Acute Care Surgery, Department of Surgery, Cali, Colombia.,Universidad Icesi, Cali, Colombia
| | - Michael W Parra
- Broward General Level I Trauma Center, Department of Trauma Critical Care, Fort Lauderdale, FL, USA
| | - Mauricio Millán
- Universidad Icesi, Cali, Colombia.,Fundación Valle del Lili, Department of Surgery, Division of Transplant Surgery, Cali, Colombia
| | - Yaset Caicedo
- Fundación Valle del Lili, Centro de Investigaciones Clínicas (CIC), Cali, Colombia
| | - Mónica Guzmán-Rodríguez
- Universidad de Chile, Facultad de Medicina, Instituto de Ciencias Biomédicas, Santiago de Chile, Chile
| | - Natalia Padilla
- Fundación Valle del Lili, Centro de Investigaciones Clínicas (CIC), Cali, Colombia
| | - Juan Carlos Salamea-Molina
- Hospital Vicente Corral Moscoso, Division of Trauma and Acute Care Surgery, Cuenca, Ecuador.,Universidad del Azuay, Escuela de Medicina, Cuenca, Ecuador
| | - Alberto García
- Fundación Valle del Lili, Department of Surgery, Division of Trauma and Acute Care Surgery, Cali, Colombia.,Universidad del Valle, Facultad de Salud, Escuela de Medicina, Division of Trauma and Acute Care Surgery, Department of Surgery, Cali, Colombia.,Universidad Icesi, Cali, Colombia
| | - Adolfo González-Hadad
- Universidad del Valle, Facultad de Salud, Escuela de Medicina, Division of Trauma and Acute Care Surgery, Department of Surgery, Cali, Colombia.,Hospital Universitario del Valle, Department of Surgery, Division of Trauma and Acute Care Surgery, Cali, Colombia.,Centro Médico Imbanaco, Cali, Colombia
| | - Luis Fernando Pino
- Universidad del Valle, Facultad de Salud, Escuela de Medicina, Division of Trauma and Acute Care Surgery, Department of Surgery, Cali, Colombia.,Hospital Universitario del Valle, Department of Surgery, Division of Trauma and Acute Care Surgery, Cali, Colombia
| | - Mario Alain Herrera
- Universidad del Valle, Facultad de Salud, Escuela de Medicina, Division of Trauma and Acute Care Surgery, Department of Surgery, Cali, Colombia.,Hospital Universitario del Valle, Department of Surgery, Division of Trauma and Acute Care Surgery, Cali, Colombia
| | - Fernando Rodríguez-Holguín
- Fundación Valle del Lili, Department of Surgery, Division of Trauma and Acute Care Surgery, Cali, Colombia
| | - José Julián Serna
- Fundación Valle del Lili, Department of Surgery, Division of Trauma and Acute Care Surgery, Cali, Colombia.,Fundación Valle del Lili, Department of Surgery, Division of Trauma and Acute Care Surgery, Cali, Colombia.,Universidad Icesi, Cali, Colombia.,Hospital Universitario del Valle, Department of Surgery, Division of Trauma and Acute Care Surgery, Cali, Colombia
| | - Alexander Salcedo
- Fundación Valle del Lili, Department of Surgery, Division of Trauma and Acute Care Surgery, Cali, Colombia.,Fundación Valle del Lili, Department of Surgery, Division of Trauma and Acute Care Surgery, Cali, Colombia.,Universidad Icesi, Cali, Colombia.,Hospital Universitario del Valle, Department of Surgery, Division of Trauma and Acute Care Surgery, Cali, Colombia
| | - Gonzalo Aristizábal
- Fundación Valle del Lili, Department of Surgery, Division of Trauma and Acute Care Surgery, Cali, Colombia
| | - Claudia Orlas
- Brigham & Women's Hospital, Department of Surgery, Center for Surgery and Public Health, Boston, USA.,Harvard Medical School & Harvard T.H., Chan School of Public Health, Boston, USA
| | - Ricardo Ferrada
- Universidad del Valle, Facultad de Salud, Escuela de Medicina, Division of Trauma and Acute Care Surgery, Department of Surgery, Cali, Colombia.,Centro Médico Imbanaco, Cali, Colombia
| | - Thomas Scalea
- University of Maryland, School of Medicine, Department of Surgery, Baltimore, MD USA
| | - Rao Ivatury
- Professor Emeritus Virginia Commonwealth University, Richmond, VA, USA
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5
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Hepatic autotransplant for hepatic vein avulsion after blunt abdominal trauma. J Trauma Acute Care Surg 2020; 89:e55-e58. [PMID: 32345904 DOI: 10.1097/ta.0000000000002750] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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6
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The effect of steatosis and fibrosis on blunt force vulnerability of the liver. Int J Legal Med 2020; 134:1067-1072. [PMID: 31938832 PMCID: PMC7181547 DOI: 10.1007/s00414-019-02245-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2019] [Accepted: 12/30/2019] [Indexed: 01/22/2023]
Abstract
The aim of our study was to examine the possible effect of steatosis and fibrosis on the blunt force vulnerability of human liver tissue. 3.5 × 3.5 × 2-cm-sized liver tissue blocks were removed from 135 cadavers. All specimens underwent microscopical analysis. The tissue samples were put into a test stand, and a metal rod with a square-shaped head was pushed against the capsular surface. The force (Pmax) causing liver rupture was measured and registered with a Mecmesin AFG-500 force gauge. Six groups were formed according to the histological appearance of the liver tissue: intact (group 1), mild steatosis (group 2), moderate steatosis (group 3), severe steatosis (group 4), fibrosis (group 5), and cirrhosis (group 6). The average Pmax value was 34.1 N in intact liver samples (range from 18.1 to 60.8 N, SD ± 8.7), 45.1 N in mild steatosis (range from 24.2 to 79.8 N SD ± 12.6), 55.4 N in moderate steatosis (range from 28.9 to 92.5 N, SD ± 16.0), 57.6 N in severe steatosis (range from 39.8 to 71.5 N, SD ± 11.9), 63.7 N in fibrosis (range from 37.8 to 112.2 N, SD ± 19.5), and 87.1 N in the case of definite cirrhosis (range from 52.7 to 162.7 N, 30.3). The Pmax values were significantly higher in samples with visible structural change than in intact liver sample (p = 0.023, 0.001, 0.009, 0.0001, 0.0001 between group 1 and groups 2 to 6 respectively). Significant difference was found between mild steatosis (group 2) and cirrhosis (group 6) (p = 0.0001), but the difference between mild, moderate, and severe steatosis (groups 2, 3, and 4) was not significant. Our study demonstrated that contrary to what is expected as received wisdom dictates, the diseases of the parenchyma (steatosis and presence of fibrosis) positively correlate with the blunt force resistance of the liver tissue.
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7
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Fan J, Tekin A, Tzakis A, Misra S. Liver Transplantation Following Life-threatening Abdominal Trauma: A Case Series of 5 Patients at a Single Institution. Transplant Proc 2019; 51:1902-1906. [PMID: 31155306 DOI: 10.1016/j.transproceed.2019.04.042] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2019] [Revised: 04/01/2019] [Accepted: 04/22/2019] [Indexed: 12/11/2022]
Abstract
Managing traumatic liver injury (TLI) is always challenging and demands precise clinical judgment. Currently, treatment of TLI in most circumstances is non-operative; however, surgical therapy might be required for severe TLI, particularly those that result in extensive blood loss. In the current institutional study carried out from June 1995 to April 2017, we describe our experience with 5 patients who received an orthotopic liver transplant for severe TLI. One patient passed away postoperatively from cerebral edema; 1 patient died of renal failure 4 years after the liver transplantation, and 3 patients are still alive. Based on our experience, we conclude that in patients with TLI, especially those with uncontrollable bleeding or those who develop liver failure, liver transplantation should be taken into consideration.
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Affiliation(s)
- Ji Fan
- Brandon Regional Medical Center, Brandon, FL, United States; Miami Transplant Institute, University of Miami, Miami, FL, United States.
| | - Akin Tekin
- Miami Transplant Institute, University of Miami, Miami, FL, United States
| | | | - Subhasis Misra
- Brandon Regional Medical Center, Brandon, FL, United States
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8
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A Curious Case of Coil-Angitis. ACG Case Rep J 2019; 6:e00078. [PMID: 31616751 PMCID: PMC6658066 DOI: 10.14309/crj.0000000000000078] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/13/2018] [Accepted: 02/28/2019] [Indexed: 11/20/2022] Open
Abstract
A 43-year-old man with a history of pedestrian-truck collision 18 months prior presented with right-sided abdominal pain and chills. His trauma consisted of orthopedic injuries and a grade 4 liver laceration. Surgical liver repair was complicated by a biloma requiring common bile duct stenting. Postendoscopy hemobilia led to extensive coiling of a hepatic artery pseudoaneurysm. Remaining hospitalization was relatively uneventful, and he was lost to follow-up. Repeat presentation was marked by leukocytosis and obstructive transaminitis. Computed tomography raised concern for a dilated 14-mm common bile duct with migrated coil mass near the pancreatic head. The patient underwent urgent endoscopic retrograde cholangiopancreatography with cholangioscopy and successful removal of a coil mass measuring approximately 4 × 3 cm without injury to the common bile duct or vascular structures. His pain was relieved, and he was discharged with a common bile duct stent and outpatient follow-up.
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9
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In silico simulation of liver crack detection using ultrasonic shear wave imaging. BMC Med Imaging 2018; 18:15. [PMID: 29769030 PMCID: PMC5956542 DOI: 10.1186/s12880-018-0249-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2017] [Accepted: 04/16/2018] [Indexed: 12/31/2022] Open
Abstract
Background Liver trauma is an important source of morbidity and mortality worldwide. A timely detection and precise evaluation of traumatic liver injury and the bleeding site is necessary. There is a need to develop better imaging modalities of hepatic injuries to increase the sensitivity of ultrasonic imaging techniques for sites of hemorrhage caused by cracks. In this study, we conduct an in silico simulation of liver crack detection and delineation using an ultrasonic shear wave imaging (USWI) based method. Methods We simulate the generation and propagation of the shear wave in a liver tissue medium having a crack using COMSOL. Ultrasound radio frequency (RF) signal synthesis and the two-dimensional speckle tracking algorithm are applied to simulate USWI in a medium with randomly distributed scatterers. Crack detection is performed using the directional filter and the edge detection algorithm rather than the conventional inversion algorithm. Cracks with varied sizes and locations are studied with our method and the crack localization results are compared with the given crack. Results Our pilot simulation study shows that, by using USWI combined with a directional filter cum edge detection technique, the near-end edge of the crack can be detected in all the three cracks that we studied. The detection errors are within 5%. For a crack of 1.6 mm thickness, little shear wave can pass through it and the far-end edge of the crack cannot be detected. The detected crack lengths using USWI are all slightly shorter than the actual crack length. The robustness of our method in detecting a straight crack, a curved crack and a subtle crack of 0.5 mm thickness is demonstrated. Conclusions In this paper, we simulate the use of a USWI based method for the detection and delineation of the crack in liver. The in silico simulation helps to improve understanding and interpretation of USWI measurements in a physical scattered liver medium with a crack. This pilot study provides a basis for improved insights in future crack detection studies in a tissue phantom or liver.
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10
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Xu H, Jie L, Kejian S, Xiaojun H, Chengli L, Hongyi Z, Yalin K. Selective Angiographic Embolization of Blunt Hepatic Trauma Reduces Failure Rate of Nonoperative Therapy and Incidence of Post-Traumatic Complications. Med Sci Monit 2017; 23:5522-5533. [PMID: 29155699 PMCID: PMC5706383 DOI: 10.12659/msm.905115] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Background Conflict still remains as to the benefit of angioembolization (AE) for non-operative therapy (NOT) of blunt hepatic trauma (BHT). The aim of this study was to determine whether AE could result in lower failure rates in hemodynamically stable BHT patients with high failure risk factors for NOT, and to systematically evaluate the effectiveness of AE for NOT of BHT. Material/Methods Medical records of all BHT patients from January 1, 1998 to December 31, 2015 at a large trauma center were collected and analyzed. Failure of NOT (FNOT) occurred if hepatic surgery was performed after attempted NOT. Logistic regression analysis was used to identify factors associated with FNOT. Hepatobiliary complications related to hepatic trauma during follow-up were reviewed. Results No significant difference in FNOT for the no angiographic embolization (NO-AE) group versus angiographic embolization (AE) group was found in hepatic trauma of grades I, II, and V. However, decrease in FNOT was significant with AE performed for hepatic trauma of grades III to IV. Risk factors for FNOT included grade III to IV injuries and contrast blush on CT. Follow-up data of six months also showed that the incidence of hepatobiliary complications in the NO-AE group was higher than the AE group. Conclusions Hemodynamically stable BHT patients with grade III to IV injuries, contrast blush on initial CT, and/or decreasing hemoglobin levels can be candidates for selective AE during NOT course.
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Affiliation(s)
- Han Xu
- Department of Hepatobiliary Surgery, Zibo Central Hospital, Zibo, Shandong, China (mainland)
| | - Li Jie
- Department of Hepatobiliary Surgery, Zibo Central Hospital, Zibo, Shandong, China (mainland)
| | - Sun Kejian
- Department of Hepatobiliary Surgery, Zibo Central Hospital, Zibo, Shandong, China (mainland)
| | - He Xiaojun
- Department of Hepatobiliary Surgery, Chinese PLA Air Force General Hospital, Beijing, China (mainland)
| | - Liu Chengli
- Department of Hepatobiliary Surgery, Chinese PLA Air Force General Hospital, Beijing, China (mainland)
| | - Zhang Hongyi
- Department of Hepatobiliary Surgery, Chinese PLA Air Force General Hospital, Beijing, China (mainland)
| | - Kong Yalin
- Department of Hepatobiliary Surgery, Chinese PLA Air Force General Hospital, Beijing, China (mainland)
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11
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Barrie J, Jamdar S, Iniguez MF, Bouamra O, Jenks T, Lecky F, O'Reilly DA. Improved outcomes for hepatic trauma in England and Wales over a decade of trauma and hepatobiliary surgery centralisation. Eur J Trauma Emerg Surg 2017; 44:63-70. [PMID: 28204851 PMCID: PMC5808051 DOI: 10.1007/s00068-017-0765-y] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2016] [Accepted: 01/20/2017] [Indexed: 11/30/2022]
Abstract
Background Over the last decade trauma services have undergone a reconfiguration in England and Wales. The objective is to describe the epidemiology, management and outcomes for liver trauma over this period and examine factors predicting survival. Methods Patients sustaining hepatic trauma were identified using the Trauma Audit and Research Network database. Demographics, management and outcomes were assessed between January 2005 and December 2014 and analysed over five, 2-year study periods. Independent predictor variables for the outcome of liver trauma were analysed using multiple logistic regression. Results 4368 Patients sustained hepatic trauma (with known outcome) between January 2005 and December 2014. Median age was 34 years (interquartile range 23–49). 81% were due to blunt and 19% to penetrating trauma. Road traffic collisions were the main mechanism of injury (58.2%). 241 patients (5.5%) underwent liver-specific surgery. The overall 30-day mortality rate was 16.4%. Improvements were seen in early consultant input, frequency and timing of computed tomography (CT) scanning, use of tranexamic acid and 30-day mortality over the five time periods. Being treated in a unit with an on-site HPB service increased the odds of survival (odds ratio 3.5, 95% confidence intervals 2.7–4.5). Conclusions Our study has shown that being treated in a unit with an on-site HPB service increased the odds of survival. Further evaluation of the benefits of trauma and HPB surgery centralisation is warranted.
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Affiliation(s)
- J Barrie
- Department of Hepato-pancreatobiliary Surgery, Manchester Royal Infirmary, Central Manchester Foundation Trust, Oxford Rd, Manchester, M13 9WL, UK
| | - S Jamdar
- Department of Hepato-pancreatobiliary Surgery, Manchester Royal Infirmary, Central Manchester Foundation Trust, Oxford Rd, Manchester, M13 9WL, UK
| | - M F Iniguez
- Trauma Audit and Research Network (TARN), Manchester Academic Health Science Centre, The University of Manchester, Manchester, M6 8HD, UK
| | - O Bouamra
- Trauma Audit and Research Network (TARN), Manchester Academic Health Science Centre, The University of Manchester, Manchester, M6 8HD, UK
| | - T Jenks
- Trauma Audit and Research Network (TARN), Manchester Academic Health Science Centre, The University of Manchester, Manchester, M6 8HD, UK
| | - F Lecky
- Trauma Audit and Research Network (TARN), Manchester Academic Health Science Centre, The University of Manchester, Manchester, M6 8HD, UK.,EMRiS Group, HSR Section, School of Health and Related Research, University of Sheffield, Sheffield, UK
| | - D A O'Reilly
- Department of Hepato-pancreatobiliary Surgery, Manchester Royal Infirmary, Central Manchester Foundation Trust, Oxford Rd, Manchester, M13 9WL, UK. .,School of Medical Sciences, The University of Manchester, Manchester, UK.
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12
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Zhao DW, Tian M, Zhang LT, Li T, Bi J, He JY, Zhang YY. Effectiveness of contrast-enhanced ultrasound and serum liver enzyme measurement in detection and classification of blunt liver trauma. J Int Med Res 2017; 45:170-181. [PMID: 28222646 PMCID: PMC5536591 DOI: 10.1177/0300060516678525] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Objective This study was performed to identify the correlation between contrast-enhanced ultrasound (CEUS) and contrast-enhanced multidetector computed tomography (CE-MDCT) as well as the correlation between serum liver enzyme concentrations and CE-MDCT in classification of the severity of blunt hepatic trauma using CE-MDCT as a reference standard. Materials and methods A blunt liver trauma model was created using 20 rabbits, and CE-MDCT, CEUS, and serum liver enzyme assays were performed. A radiologist and an ultrasound physician independently evaluated the degree of liver trauma. The diagnostic performance of CEUS and serum liver enzyme measurements was compared with that of CE-MDCT using Spearman’s correlation analysis and Pearson’s correlation analysis, respectively. Results Spearman’s rank correlation coefficient between the CEUS-based classification and CE-MDCT was 0.888. The aspartate aminotransferase and lactate dehydrogenase concentrations and the aspartate aminotransferase/alanine aminotransferase ratio were positively correlated with the grade of liver injury; Pearson’s correlation coefficients were 0.664, 0.704, and 0.503, respectively. The gamma-glutamyltransferase concentration had a significantly negative correlation with the grade of liver injury (r = −0.467). Conclusions CEUS and serum liver enzyme measurement exhibited high consistency with CE-MDCT for both detection and grading of intraparenchymal lesions in blunt liver trauma. These techniques may permit more accurate diagnosis of liver trauma.
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Affiliation(s)
- Da-Wei Zhao
- 1 Department of Ultrasound, Daping Hospital & Institute of Surgery Research, Third Military Medical University, Chongqing, China
| | - Meng Tian
- 1 Department of Ultrasound, Daping Hospital & Institute of Surgery Research, Third Military Medical University, Chongqing, China
| | - Le-Tian Zhang
- 2 Department of Radiology, Daping Hospital & Institute of Surgery Research, Third Military Medical University, Chongqing, China
| | - Tao Li
- 1 Department of Ultrasound, Daping Hospital & Institute of Surgery Research, Third Military Medical University, Chongqing, China
| | - Jie Bi
- 1 Department of Ultrasound, Daping Hospital & Institute of Surgery Research, Third Military Medical University, Chongqing, China
| | - Jia-Ying He
- 1 Department of Ultrasound, Daping Hospital & Institute of Surgery Research, Third Military Medical University, Chongqing, China
| | - Ying-Ying Zhang
- 1 Department of Ultrasound, Daping Hospital & Institute of Surgery Research, Third Military Medical University, Chongqing, China
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13
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Zhao DW, Tian M, Yang JZ, Du P, Bi J, Zhu X, Li T. Hemostatic mechanism underlying microbubble-enhanced non-focused ultrasound in the treatment of a rabbit liver trauma model. Exp Biol Med (Maywood) 2016; 242:231-240. [PMID: 27633577 DOI: 10.1177/1535370216669835] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
The aim of our study was to investigate the hemostatic mechanism underlying microbubble-enhanced non-focused ultrasound treatment of liver trauma. Thirty rabbits with liver trauma were randomly divided into three groups-the microbubble-enhanced ultrasound (MEUS; further subdivided based on exposure intensity into MEUS1 [0.11 W/cm2], MEUS2 [0.55 W/cm2], and MEUS3 [1.1 W/cm2]), ultrasound without microbubbles (US), and microbubbles without ultrasound (MB) groups. The pre- and post-treatment bleeding weight and visual bleeding scores were evaluated. The serum liver enzyme concentrations as well as the blood perfusion level represented by mean peak contrast intensity (PI) ratio in the treatment area were analyzed. The hemostatic mechanism was evaluated by histological and transmission electron microscopic examination of liver tissue samples. The MEUS subgroups 1-3 (grade 0-1, grade 0-2, and grade 1-2, respectively) exhibited significantly lower post-treatment visual bleeding scores than the US and MB groups (both, grade 3-4; all, P < 0.05). Subgroups MEUS1 (0.346 ± 0.345 g) and MEUS2 (2.232 ± 2.256 g) exhibited significantly lower post-treatment bleeding weight than the US and MB groups (5.698 ± 1.938 and 5.688 ± 2.317 g, respectively; all, P < 0.05). Additionally, MEUS subgroups 1-3 exhibited significantly lower post-treatment blood perfusion levels (PI ratios, 0.64 ± 0.085, 0.73 ± 0.045, and 0.84 ± 0.034, respectively) than the US and MB groups (PI ratios, 1.00 ± 0.005 and 0.99 ± 0.005, respectively; all, P < 0.05). In the MEUS group, hepatic cells became edematous and compressed the hepatic sinus and associated blood vessels. However, the serum liver enzyme levels were not significantly altered. Microbubble-enhanced non-focused ultrasound does not significantly affect blood perfusion and liver function and can be used to induce rapid hemostasis in case of liver trauma.
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Affiliation(s)
- Da-Wei Zhao
- 1 Department of Ultrasound, Daping Hospital & Institute of Surgery Research, Third Military Medical University, Chongqing 400042, P.R. China
| | - Meng Tian
- 1 Department of Ultrasound, Daping Hospital & Institute of Surgery Research, Third Military Medical University, Chongqing 400042, P.R. China
| | - Jian-Zheng Yang
- 1 Department of Ultrasound, Daping Hospital & Institute of Surgery Research, Third Military Medical University, Chongqing 400042, P.R. China
| | - Peng Du
- 1 Department of Ultrasound, Daping Hospital & Institute of Surgery Research, Third Military Medical University, Chongqing 400042, P.R. China
| | - Jie Bi
- 1 Department of Ultrasound, Daping Hospital & Institute of Surgery Research, Third Military Medical University, Chongqing 400042, P.R. China
| | - Xinjian Zhu
- 2 State Key Laboratory of Trauma, Burns and Combined Injury, Daping Hospital & Institute of Surgery Research, Third Military Medical University, Chongqing 400042, P.R. China
| | - Tao Li
- 1 Department of Ultrasound, Daping Hospital & Institute of Surgery Research, Third Military Medical University, Chongqing 400042, P.R. China
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14
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Smoliar AN, Dzhagraev KR. [One-stage surgical treatment of severe closed combined liver trauma]. Khirurgiia (Mosk) 2015:79-81. [PMID: 26031825 DOI: 10.17116/hirurgia2015279-81] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Affiliation(s)
- A N Smoliar
- Otdelenie ostrykh khirurgicheskikh zabolevaniĭ pecheni i podzheludochnoĭ zhelezy Nauchno-issledovatel'skogo instituta skoroĭ pomoshchi im. N.V. Sklifosovskogo, Moskva
| | - K R Dzhagraev
- Otdelenie ostrykh khirurgicheskikh zabolevaniĭ pecheni i podzheludochnoĭ zhelezy Nauchno-issledovatel'skogo instituta skoroĭ pomoshchi im. N.V. Sklifosovskogo, Moskva
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15
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Chai YS, Lee JK, Heo SJ, Lee YK, Lee YW, Jo YH, Park SS, Kim HJ, Kang IG. Traumatic Liver Injury: Factors Associated with Mortality. Korean J Crit Care Med 2014. [DOI: 10.4266/kjccm.2014.29.4.320] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Affiliation(s)
- Youn Suk Chai
- Department of Emergency Medicine, Konyang University Hospital, Daejeon, Korea
| | - Jae Kwang Lee
- Department of Emergency Medicine, Konyang University Hospital, Daejeon, Korea
| | - Seok Jin Heo
- Department of Emergency Medicine, Konyang University Hospital, Daejeon, Korea
| | - Yeong Ki Lee
- Department of Emergency Medicine, Konyang University Hospital, Daejeon, Korea
| | - Yong Woo Lee
- Department of Emergency Medicine, Konyang University Hospital, Daejeon, Korea
| | - Young Hwa Jo
- Department of Emergency Medicine, Konyang University Hospital, Daejeon, Korea
| | - Seong Soo Park
- Department of Emergency Medicine, Konyang University Hospital, Daejeon, Korea
| | - Hyun Jin Kim
- Department of Emergency Medicine, Konyang University Hospital, Daejeon, Korea
| | - In Gu Kang
- Department of Emergency Medicine, Konyang University Hospital, Daejeon, Korea
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