1
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Dalcin RR, Petrillo Y, Alves L, Fonseca MK, Almeida AS, Corso CO. Selective nonoperative versus operative management of liver gunshot injuries: a retrospective cohort study. Ann R Coll Surg Engl 2024. [PMID: 38787286 DOI: 10.1308/rcsann.2022.0061] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/25/2024] Open
Abstract
INTRODUCTION Experience accumulated over the last decades suggests nonoperative management (NOM) of civilian gunshot liver injuries can be safely applied in selected cases. This study aims to compare the outcomes of selective NOM versus operative management (OM) of patients sustaining gunshot wounds (GSW) to the liver. METHODS A registry-based retrospective cohort analysis was performed for the period of 2008 to 2016 in a Brazilian trauma referral. Patients aged 16-80 years sustaining civilian GSW to right-sided abdominal quadrants and liver injury were included. Baseline data, vital signs, grade of liver injury, associated injuries, injury severity scores, blood transfusion requirements, liver- and non-liver-related complications, length-of-stay (LOS), and mortality were retrieved from individual registries. RESULTS A total of 54 patients were eligible for analysis, of which 37 underwent NOM and 17 underwent OM. The median age was 25 years and all were male. No statistically significant differences were observed between groups regarding patients' demographics, injury scores, grade of liver injury and associated lesions. NOM patients tended to sustain higher-grade injuries (86.5% vs 64.7%; p = 0.08), and failure of conservative management was recorded in two (5.4%) cases. The rate of complications was 48% with no between-group statistically significant difference. Blood transfusion requirements were significantly higher in the OM group (58.8% vs 21.6%; p = 0.012). The median LOS was seven days. No deaths were recorded. CONCLUSION Patients with liver GSW who are haemodynamically stable and without peritonitis are candidates for NOM. In this study, NOM was safe and effective even in high-grade injuries.
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Affiliation(s)
- R R Dalcin
- Federal University of Rio Grande do Sul (UFRGS), Porto Alegre, Brazil
- Hospital de Pronto Socorro de Porto Alegre, Brazil
| | - Ytm Petrillo
- Hospital de Pronto Socorro de Porto Alegre, Brazil
| | - Lac Alves
- Hospital de Pronto Socorro de Porto Alegre, Brazil
| | - M K Fonseca
- Hospital de Pronto Socorro de Porto Alegre, Brazil
| | - A S Almeida
- Hospital Nossa Senhora da Conceição, Porto Alegre, Brazil
| | - C O Corso
- Federal University of Rio Grande do Sul (UFRGS), Porto Alegre, Brazil
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2
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Perihepatic Abscess due to a Liver Suture with Pledgets Used to Treat a Penetrating Liver Injury. Case Rep Emerg Med 2021; 2021:6817617. [PMID: 34659844 PMCID: PMC8514939 DOI: 10.1155/2021/6817617] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2021] [Accepted: 09/15/2021] [Indexed: 11/17/2022] Open
Abstract
Background Selective nonoperative management has become the standard for liver injuries. Accordingly, we cannot perform surgery for liver injuries as frequently as in the past. This report is aimed at sharing a valuable experience of postoperative complications after surgery for a liver injury. Case Presentation. A 40-year-old man was stabbed in his abdomen and underwent an emergency laparotomy for a severe liver injury. Five months after the operation, he developed fever, and purulent discharge was observed from an abdominal fistula. He was diagnosed with a perihepatic abscess and duodenal perforation due to the pledgets used for the operation. He underwent a second surgery to remove the pledgets and the abscess cavity for infection control and was discharged in good condition. Conclusion The intra-abdominal environment should be considered contaminated due to bile leakage in surgeries following liver injury. Furthermore, nonabsorbable agents should not be used in these contaminated areas.
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3
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Abstract
Trauma is the leading cause of death in patients younger than 45 years. Over the last decade, there has been a progressive paradigm shift toward a nonoperative management of many blunt and penetrating injuries, placing interventional radiology in the forefront in this critical field. Transcatheter embolization is an established technique that plays a significant role in the modern treatment of traumatic injuries of the extremities, pelvis, and solid organs. The purpose of this article is to review the updated principles and techniques used in transcatheter embolization in trauma.
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Affiliation(s)
- Jorge E Lopera
- Department of Radiology, UT Health San Antonio, San Antonio, Texas
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4
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Kumar S, Gupta A, Sagar S, Bagaria D, Kumar A, Choudhary N, Kumar V, Ghoshal S, Alam J, Agarwal H, Gammangatti S, Kumar A, Soni KD, Agarwal R, Gunjaganvi M, Joshi M, Saurabh G, Banerjee N, Kumar A, Rattan A, Bakhshi GD, Jain S, Shah S, Sharma P, Kalangutkar A, Chatterjee S, Sharma N, Noronha W, Mohan LN, Singh V, Gupta R, Misra S, Jain A, Dharap S, Mohan R, Priyadarshini P, Tandon M, Mishra B, Jain V, Singhal M, Meena YK, Sharma B, Garg PK, Dhagat P, Kumar S, Kumar S, Misra MC. Management of Blunt Solid Organ Injuries: the Indian Society for Trauma and Acute Care (ISTAC) Consensus Guidelines. Indian J Surg 2021. [DOI: 10.1007/s12262-021-02820-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
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5
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The Role of Angioembolization in Liver Trauma: the 10-Year Retrospective Experience of a Level One Trauma Center. Indian J Surg 2021. [DOI: 10.1007/s12262-021-02726-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022] Open
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6
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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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7
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Brooks A, Reilly JJ, Hope C, Navarro A, Naess PA, Gaarder C. Evolution of non-operative management of liver trauma. Trauma Surg Acute Care Open 2020; 5:e000551. [PMID: 33178894 PMCID: PMC7640583 DOI: 10.1136/tsaco-2020-000551] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2020] [Revised: 08/19/2020] [Accepted: 08/31/2020] [Indexed: 11/03/2022] Open
Abstract
The management of complex liver injury has changed during the last 30 years. Operative management has evolved into a non-operative management (NOM) approach, with surgery reserved for those who present in extremis or become hemodynamically unstable despite resuscitation. This NOM approach has been associated with improved survival rates in severe liver injury and has been the mainstay of treatment for the last 20 years. Patients that fail NOM and require emergency surgery are associated with increased morbidity and mortality. Better patient selection may have an impact not only on the rate of failure of NOM, but the mortality rate associated with it. The aim of this article is to review the evidence that helped shape the evolution of liver injury management during the last 30 years.
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Affiliation(s)
- Adam Brooks
- East Midlands Major Trauma Centre, Queen's Medical Centre, Nottingham University Hospitals NHS Trust, Nottingham, UK
| | - John-Joe Reilly
- East Midlands Major Trauma Centre, Queen's Medical Centre, Nottingham University Hospitals NHS Trust, Nottingham, UK
| | - Carla Hope
- Division of Graduate Entry Medicine and Health Sciences, University of Nottingham, Nottingham, Nottinghamshire, UK
| | - Alex Navarro
- East Midlands Major Trauma Centre, Queen's Medical Centre, Nottingham University Hospitals NHS Trust, Nottingham, UK
| | - Paal Aksel Naess
- Department of Traumatology, Oslo University Hospital Ullevaal, Oslo, Norway.,Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Christine Gaarder
- Department of Traumatology, Oslo University Hospital Ullevaal, Oslo, Norway.,Institute of Clinical Medicine, University of Oslo, Oslo, Norway
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8
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O'Neill SB, Hamid S, Nicolaou S, Qamar SR. Changes in Approach to Solid Organ Injury: What the Radiologist Needs to Know. Can Assoc Radiol J 2020; 71:352-361. [PMID: 32166970 DOI: 10.1177/0846537120908069] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
This review aims to examine the challenges facing radiologists interpreting trauma computed tomography (CT) images in this era of a changing approach to management of solid organ trauma. After reviewing the pearls and pitfalls of CT imaging protocols for detection of traumatic solid organ injuries, we describe the key changes in the 2018 American Association for the Surgery of Trauma Organ Injury Scales for liver, spleen, and kidney and their implications for management strategies. We then focus on the important imaging findings in observed in patients who undergo nonoperative management and patients who are imaged post damage control surgery.
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Affiliation(s)
- Siobhán B O'Neill
- Department of Emergency Radiology, University of British Columbia, Vancouver General Hospital, Vancouver, British Columbia, Canada
| | - Saira Hamid
- Department of Emergency Radiology, University of British Columbia, Vancouver General Hospital, Vancouver, British Columbia, Canada
| | - Savvas Nicolaou
- Department of Emergency Radiology, University of British Columbia, Vancouver General Hospital, Vancouver, British Columbia, Canada
| | - Sadia R Qamar
- Department of Emergency Radiology, University of British Columbia, Vancouver General Hospital, Vancouver, British Columbia, Canada
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9
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Becker A, Peleg K, Dubose J, Daskal Y, Givon A, Kessel B. Abdominal stab wound injury in children: Do we need a different approach? J Pediatr Surg 2019; 54:780-782. [PMID: 29843907 DOI: 10.1016/j.jpedsurg.2018.04.041] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2018] [Revised: 04/15/2018] [Accepted: 04/29/2018] [Indexed: 10/17/2022]
Abstract
BACKGROUND Penetrating stab wounds in children are relatively rare and no clear recommendations for the optimal evaluation have been devised. An acceptable traditional approach to the patient with an abdominal stab wound who does not require urgent surgery is selective nonoperative management and serial exams. The use of routine computed tomography remains an actively utilized investigation for these patients at many institutions. PURPOSE We hypothesize that the approach to pediatric stab wound victims should be distinctly different than that of adult counterparts in order to minimize radiation exposure. METHODS A retrospective cohort study involving abdominal stab wounds among pediatric trauma patients (age < 14) compared with adults between the years 1997 and 2016 was conducted utilizing the Israeli National Trauma Registry. RESULTS A total of 92 children and 4444 adults were identified from the registry for inclusion. Among the children 20 (21.7%) patients had intraabdominal injury compared to 1730 (38.9%) among adult counterparts. Four children were hemodynamically unstable, two of them were referred directly to operating room and two others were treated without surgery. Among the remaining 88 children there was no observed mortality. CONCLUSIONS The majority of pediatric stab wounds trauma victims have minor abdominal injuries. We do not recommend the routine utilization of abdominal CT scan in the evaluation of abdominal stab wounds. Observation with serial exams and minimization of radiation exposure from CT are warranted in this unique population. TYPE OF STUDY Retrospective comparative study. LEVEL OF EVIDENCE 3.
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Affiliation(s)
| | - Kobi Peleg
- National Center for Trauma and Emergency Medicine Research, Gertner Institute for Epidemiology and Health Policy Research, Tel Hashomer, Israel; Emergency and Disaster Management Department, Faculty of Medicine, School of Public Health, Tel-Aviv University, Israel
| | - Joseph Dubose
- R Adams Cowley Shock Trauma Center, University of Maryland Medical System, Baltimore, MD, USA
| | - Yaakov Daskal
- Trauma Unit, Hillel Yaffe Medical Center, Hadera, Israel
| | - Adi Givon
- National Center for Trauma and Emergency Medicine Research, Gertner Institute for Epidemiology and Health Policy Research, Tel Hashomer, Israel
| | - Boris Kessel
- Trauma Unit, Hillel Yaffe Medical Center, Hadera, Israel
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10
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Akkoca M, Balas S, Yilmaz KB, Tatar IG, Akinci M, Tokgoz S, Tamam S, Karabacak H. CT-guided tractography is a safe and complementary diagnostic tool in the management of penetrating abdominal trauma. Asian J Surg 2018; 42:148-154. [PMID: 30585169 DOI: 10.1016/j.asjsur.2018.05.007] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2018] [Revised: 05/07/2018] [Accepted: 05/28/2018] [Indexed: 10/28/2022] Open
Abstract
BACKGROUND/OBJECTIVE Despite extensive published research, the surgical approach to penetrating abdominal trauma patients is still under debate. Computed tomography-guided tractography (CTT) is an imaging modality in which water soluble iodinated contrast medium is administered into the site of the injury in the CT unit. The aim of this study was to determine the diagnostic accuracy of the CTT. METHODS A retrospective evaluation was made of patients admitted to the Emergency Department with penetrating abdominal trauma and who underwent CTT. Contrast enhanced abdominal CT and CTT reports, surgical findings and clinical results were examined. RESULTS Evaluation was made of a total of 101 patients comprising 89 males (88.1%) and 12 females (11.9%). CTT was determined to have 92.8% sensitivity, 93.6% specificity, 97% positive predictive value, and 85.5% negative predictive value. In 27 patients (26.7%) where the CTT indicated passage through the peritoneum, no parenchymal organ injury was present. Only one patient (2.9%) without peritoneal penetration on CTT had organ injury at exploration. No procedure-related morbidities developed. CONCLUSION CTT is a safe imaging modality for the evaluation of hemodynamically stable patients. Compared to other imaging modalities, there is clearer demonstration of whether or not the peritoneum is intact. However penetration on CTT does not exactly correlate with organ injury.
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Affiliation(s)
- Muzaffer Akkoca
- University of Health Sciences, Dışkapı Yıldırım Beyazıt Research and Training Hospital, Department of General Surgery, Ankara, Turkey.
| | - Sener Balas
- University of Health Sciences, Dışkapı Yıldırım Beyazıt Research and Training Hospital, Department of General Surgery, Ankara, Turkey
| | - Kerim Bora Yilmaz
- University of Health Sciences, Dışkapı Yıldırım Beyazıt Research and Training Hospital, Department of General Surgery, Ankara, Turkey
| | - Idil Gunes Tatar
- University of Health Sciences, Dışkapı Yıldırım Beyazıt Research and Training Hospital, Department of Radiology, Ankara, Turkey
| | - Melih Akinci
- University of Health Sciences, Dışkapı Yıldırım Beyazıt Research and Training Hospital, Department of General Surgery, Ankara, Turkey
| | - Serhat Tokgoz
- University of Health Sciences, Dışkapı Yıldırım Beyazıt Research and Training Hospital, Department of General Surgery, Ankara, Turkey
| | - Selim Tamam
- University of Health Sciences, Dışkapı Yıldırım Beyazıt Research and Training Hospital, Department of General Surgery, Ankara, Turkey
| | - Harun Karabacak
- University of Health Sciences, Dışkapı Yıldırım Beyazıt Research and Training Hospital, Department of General Surgery, Ankara, Turkey
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11
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Virdis F, Reccia I, Di Saverio S, Tugnoli G, Kwan SH, Kumar J, Atzeni J, Podda M. Clinical outcomes of primary arterial embolization in severe hepatic trauma: A systematic review. Diagn Interv Imaging 2018; 100:65-75. [PMID: 30555019 DOI: 10.1016/j.diii.2018.10.004] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2018] [Revised: 10/06/2018] [Accepted: 10/09/2018] [Indexed: 11/25/2022]
Abstract
PURPOSE This purpose of this systematic review was to determine the safety and efficacy of arterial embolization as the primary treatment for grade III-V liver trauma, excluding the postoperative use of arterial embolization. MATERIAL AND METHODS A total of 24 studies published between January 2000 and June 2018 qualified for inclusion in this study. Four of them were prospective studies and 20 were retrospective. A total of 3855 patients (mean age, 33.5 years; range: 22-52.5 years) were treated non-operatively and 659 patients (659/3855; 17.09%) with hepatic hemorrhage underwent primary arterial embolization from 2000 to 2017. Indication for arterial embolization was a contrast blush visible on computed tomography in hemodynamically stable patient in all studies. RESULTS The arterial embolization success rate ranged from 80% to 97%. The most commonly reported complication was bile leak, with an incidence of 5.7%. Nineteen bilomas (2.8%) were reported in five studies with a range between 4% and 45%. Hepatic ischemia was reported in eight studies, with a mean incidence of 8.6%. CONCLUSION Primary arterial embolization has a high success rate in patients with hepatic trauma. Complications, including biloma and hepatic ischemia, have acceptable rates in the context of a minimally-invasive procedure that allows stabilization of life-threatening, complex liver injuries.
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Affiliation(s)
- F Virdis
- General Surgery Department, Hillingdon Hospital NHS Foundation Trust, Uxbridge, UB8 3NN, London, United Kingdom.
| | - I Reccia
- Haepato-Biliary-Pancreatic Unit, Hammersmith Hospital, Imperial College, Du Cane Road W120HS, London, United Kingdom
| | - S Di Saverio
- Department of Surgery, Addenbrooke's Hospital, Hills Rd, CB2 0QQ, Cambridge, United Kingdom
| | - G Tugnoli
- Trauma and Emergency Surgery Unit, Maggiore Hospital, Largo Nigrisoli, 2, 40133 Bologna BO, Italy
| | - S H Kwan
- Royal Perth Hospital, 97, Wellington St, Perth WA 6000, Australia
| | - J Kumar
- Department of Surgery & Cancer, Imperial College, Du Cane Road, W120HS London, United Kingdom
| | - J Atzeni
- General and Emergency Surgery Unit, Ns Signora di Bonaria Hospital, 09037 San Gavino, Italy
| | - M Podda
- General, Emergency and Robotic Surgery Unit, San Francesco Hospital, 08100 Nuoro NU, Italy
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12
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Choi AY, Bodanapally UK, Shapiro B, Patlas MN, Katz DS. Recent Advances in Abdominal Trauma Computed Tomography. Semin Roentgenol 2018; 53:178-186. [PMID: 29861009 DOI: 10.1053/j.ro.2018.02.008] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Affiliation(s)
- Andrew Y Choi
- Department of Radiology, NYU Winthrop Hospital, Mineola, NY.
| | - Uttam K Bodanapally
- Department of Diagnostic Radiology and Nuclear Medicine, University of Maryland Medical Center, R. Adams Cowley Shock Trauma Center, Baltimore, MD
| | - Boris Shapiro
- Department of Radiology, NYU Winthrop Hospital, Mineola, NY
| | - Michael N Patlas
- Division of Emergency Radiology, Department of Radiology, McMaster University, Hamilton, ON, Canada
| | - Douglas S Katz
- Department of Radiology, NYU Winthrop Hospital, Mineola, NY
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13
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Spijkerman R, Teuben MPJ, Hoosain F, Taylor LP, Hardcastle TC, Blokhuis TJ, Warren BL, Leenen LPH. Non-operative management for penetrating splenic trauma: how far can we go to save splenic function? World J Emerg Surg 2017; 12:33. [PMID: 28769999 PMCID: PMC5526240 DOI: 10.1186/s13017-017-0144-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2017] [Accepted: 07/20/2017] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Selective non-operative management (NOM) for the treatment of blunt splenic trauma is safe. Currently, the feasibility of selective NOM for penetrating splenic injury (PSI) is unclear. Unfortunately, little is known about the success rate of spleen-preserving surgical procedures. The aim of this study was to investigate the outcome of selective NOM for penetrating splenic injuries. METHODS A dual-centre study is performed in two level-one trauma centres. All identified patients treated for PSI were identified. Patients were grouped based on the treatment they received. Group one consisted of splenectomised patients, the second group included patients treated by a spleen-preserving surgical intervention, and group three included those patients who were treated by NOM. RESULTS A total of 118 patients with a median age of 27 and a median ISS of 25 (interquartile range (IQR) 16-34) were included. Ninety-six patients required operative intervention, of whom 45 underwent a total splenectomy and 51 underwent spleen-preserving surgical procedures. Furthermore, 22 patients (12 stab wounds and 10 gunshot wounds) were treated by NOM. There were several anticipated significant differences in the baseline encountered. The median hospitalization time was 8 (5-12) days, with no significant differences between the groups. The splenectomy group had significantly more intensive care unit (ICU) days (2(0-6) vs. 0(0-1)) and ventilation days (1(0-3) vs. 0(0-0)) compared to the NOM group. Mortality was only noted in the splenectomy group. CONCLUSIONS Spleen-preserving surgical therapy for PSI is a feasible treatment modality and is not associated with increased mortality. Moreover, a select group of patients can be treated without any surgical intervention at all.
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Affiliation(s)
- Roy Spijkerman
- Department of Trauma, University Medical Centre Utrecht, Heidelberglaan 100, 3584CX Utrecht, The Netherlands
| | - Michel Paul Johan Teuben
- Department of Trauma, University Medical Centre Utrecht, Heidelberglaan 100, 3584CX Utrecht, The Netherlands
| | - Fatima Hoosain
- Department of Trauma, Tygerberg Hospital (University of Stellenbosch), Francie van Zijl Avenue, Cape Town, 7505 South Africa
| | - Liezel Phyllis Taylor
- Department of Trauma, Tygerberg Hospital (University of Stellenbosch), Francie van Zijl Avenue, Cape Town, 7505 South Africa
| | - Timothy Craig Hardcastle
- Department of Trauma, Inkosi Albert Luthuli Central Hospital (University of Kwazulu-Natal), 800 Bellair Road, Durban, 4091 South Africa
| | - Taco Johan Blokhuis
- Department of Trauma, University Medical Centre Utrecht, Heidelberglaan 100, 3584CX Utrecht, The Netherlands
| | - Brian Leigh Warren
- Department of Trauma, Tygerberg Hospital (University of Stellenbosch), Francie van Zijl Avenue, Cape Town, 7505 South Africa
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14
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