Non Operative Management of Isolated Blunt Liver Trauma: A Task of High Skilled Surgeons
Journal of Surgery
Volume 5, Issue 6, December 2017, Pages: 118-123
Received: Sep. 30, 2017;
Accepted: Oct. 16, 2017;
Published: Dec. 8, 2017
Views 1694 Downloads 97
Abdallah Mohamed Taha, General Surgery Department, Faculty of Medicine, South Valley University, Qena, Egypt
Ahmed Mohamed Abdallah, General Surgery Department, Faculty of Medicine, Assuit University, Assiut, Egypt
Mostafa Mohamoud Sayed, General Surgery Department, Faculty of Medicine, Assuit University, Assiut, Egypt
Salah Ibrahim Mohamed, General Surgery Department, Faculty of Medicine, Assuit University, Assiut, Egypt
Mostafa Hamad, General Surgery Department, Faculty of Medicine, Assuit University, Assiut, Egypt
Background: Liver is the most injured organ in abdominal trauma. The management of blunt liver trauma has markedly changed in the last three decades with a significant improvement in outcomes, due to improvements in diagnostic and therapeutic aids. This study details incidence, grades, causes, types and management of blunt isolated liver trauma in trauma patients admitted to Assiut and South Valley University Hospitals. Patients and Methods: All patients having blunt liver trauma were admitted, history taking, laboratory investigations and resuscitation were performed simultaneously along with ultrasound and CT scan as needed. Data of mechanism trauma, grade of liver injury, method of intervention (Operative or non-operative) and outcome were collected, tabulated and analyzed. Results: Total 174 cases were included in this study with diagnosis of isolated blunt hepatic injuries, mostly young patients were involved, and their mean age was found 24.19+14.65 years. The majority of patients were males 138 (79.31%). Operative management was adopted in 39 patients (22.41%), non-operative management adopted in 129 patients (74.13%), and 6 patients (3.45%) died during initial resuscitation. Most cases of liver trauma were found to be grade-III hepatic injury (41.1%). Chest infection was the commonest complication after surgical management. The mortality rate (12.1%) was significantly associated with severity of injury (grade IV and V). Conclusion: Non-operative management of isolated blunt liver trauma is feasible and safe in haemodynaically stable patient with grade I-III liver injury. Mortality in grades IV and V liver trauma is significantly high, so, early operative intervention is recommended in those patients.
Abdallah Mohamed Taha,
Ahmed Mohamed Abdallah,
Mostafa Mohamoud Sayed,
Salah Ibrahim Mohamed,
Non Operative Management of Isolated Blunt Liver Trauma: A Task of High Skilled Surgeons, Journal of Surgery.
Vol. 5, No. 6,
2017, pp. 118-123.
Konstantinos Chatoupis, Glikeria Papadopoulou, and Ioannis Kaskarelis, New technology in the management of liver trauma. Ann Gastroenterol. 2013; 26 (1): 41–44.
Wong YC, Wang LJ, See LC et al., Contrast material extravasation on contrast-enhanced helical computed tomographic scan of blunt abdominal trauma: its significance on the choice, time, and outcome of treatment. J Trauma, 2003; 54: 164–170.
Coccolini FG, Giulia Montori, Fausto Catena, Salomone Di Saverio, Walter Biffl, Ernest E. Moore, Andrew B. Peitzman, Sandro Rizoli, Gregorio Tugnoli, Massimo Sartelli, Roberto Manfredi and Luca Ansaloni 1 Liver trauma: WSES position paper, Coccolini et al. World Journal of Emergency Surgery. 2015; 10:.39.
Coimbra R, Hoyt DB, Engelhart S et al., Nonoperative management reduces the overall mortality of grades 3 and 4 blunt liver injuries. Int Surg 2006. 91: 251–257.
Fang JF, Wong YC, Lin BC, et al. The CT risk factors for the need of operative treatment in initially stable patients after blunt hepatic trauma. J Trauma. 2006; 61: 547–554.
Hagiwara A, Murata A, Matsuda T, et al. The efficacy and limitations of trans arterial embolization for severe hepatic injury. J Trauma. 2002; 52: 1091–1096.
Kozar RA, Feliciano VD, Moore EE, Moore FA, Cocanour CS, West MA, Davis JW, McIntyre Jr RC. Western trauma association/critical decision in trauma: operative management of blunt hepatic trauma. J Trauma. 2011; 71 (1): 1–5.
Sartorelli KH, Frumiento C, Rogers FB, et al. Non-operative management of hepatic, splenic, and renal injuries in adults with multiple injuries. J Trauma. 2000; 49: 56–61.
Richardson JD, Franklin GA, Lukan JK, et al. Evolution in the management of hepatic trauma: a 25 year perspective. Ann Surg. 2000; 232: 324–330.
Christmas AB, Wilson AK, Manning B, et al. Selective management of blunt hepatic injuries including non-operative management is a safe and effective strategy. Surgery. 2005; 138: 606–611.
Moore EE, Cogbill TH, Jurkovich GJ, Shackford SR, Malangoni MA, Champion HR. Organ injury scaling: spleen and liver (1994 revision). J Trauma. 1995; 38: 323–4.
Thiago Messias Zago; Bruno Monteiro Pereira; Bartolomeu Nascimento; Maria Silveira Carvalho Alves; Thiago Rodrigues Araujo Calderan; Gustavo Pereira Fraga, TCBC-SP Hepatic trauma: a 21-year experience, Rev. Col. Bras. Cir. vol. 40 no. 4 Rio de Janeiro July/Aug. 2013.
Nasim Ahmed and Jerome J Vernick, Management of liver trauma in adults, J Emerg Trauma Shock. 2011 Jan-Mar; 4 (1): 114–119.
Taourel P, Vernhet H, Suau A, Granier C, Lopez FM, Aufort S, et al. Vascular emergencies in liver trauma. Eur J Radiol. 2007; 64: 73–82.
Demetriades D, Hadjizacharia P, Constantinou C, Brown C, Inaba K, Rhee P, et al. Selective nonoperative management of penetrating abdominal solid organ injuries. Ann Surg. 2006; 244: 620–8.
Schweizer W, Tanner S, Baer HU et al. Management of traumatic liver injuries. Br J Surg 2006; 80:86–88.
Duane, T. M., Como, J. J., Bochichio, G. V., et al. (2004). Re-evaluating the management and outcomes of severe blunt liver injury. J Trauma, 57, 494-500.
Ayman ZakiAzzam, Abdel Hamid Gazal, Mohammed I. Kassem, Magdy A. Souror. The role of non-operative management (NOM) in blunt hepatic trauma, Alexandria Journal of Medicine Volume 49, Issue 3, September 2013, Pages 223–227.
Yaman I, Nazli O, Tugrul T, Isguder AS, Bozdag AD, Bolukbasi H. Surgical treatment of hepatic injury: morbidity and mortality analysis of 109 cases. Hepatogastroenterology 2007; 54 (77):1507–11.
Bala M, Gazalla SA, Faroja M, Bloom AI, Zamir G, Rivkind AI, Almogy G. Complications of high grade liver injuries: management and outcome with focus on bile leaks. Scandinavian journal of trauma, resuscitation and emergency medicine. 2012 Mar 23; 20 (1):20.