scholarly journals Povrede jetre - nasa iskustva u tretmanu

2010 ◽  
Vol 57 (1) ◽  
pp. 101-106
Author(s):  
G. Vukovic ◽  
B. Stefanovic ◽  
G. Kaljevic ◽  
V. Vukojevic ◽  
V. Resanovic ◽  
...  
Keyword(s):  
Liver Injury ◽  
Damage Control ◽  
Damage Control Surgery ◽  
Liver Trauma ◽  
Young Population ◽  
Liver Injuries ◽  
Critical Patients ◽  
Care Problems ◽  
Isolated Liver ◽  
Standard Strategy

Background: Trauma is one of today's most serious and expensive health care problems, and it is the most common cause of mortality in young population. Non-operative treatment is standard strategy for management of blunt liver injuries in hemodynamically stable patients in last decade. Methods: Retrospective study included patients with liver trauma, admitted in the period december 1995-december 2005, in total 476. Results: 392 of 476 patients presenting with liver trauma had blunt and only 84 had penetrating injury. Isolated liver injury was identified in 27,5% and 72,5% had associated injuries. Average ISS value was 24.06 (SD=14.26). During the operation liver injury in patients was classified according to Moor. In 2% critical patients, due to hemodynamic unstability we performed 'damage control surgery'. Out of 476 patients 87,% were successfully managet, 6,1% died as 'mors in tabula' or during first 24 hours and 6,9% died during hospitalization. Conclusion: Higher proportion of nonoopertively treated is among patients with ISS less than and those with injuries grade I end II.

Surgical Management of Complex Liver Trauma: A Single Liver Transplant Center Experience

2012 ◽  
Vol 78 (1) ◽  
pp. 20-25 ◽  
Author(s):  
Sergio Li Petri ◽  
Salvatore Gruttadauria ◽  
Duilio Pagano ◽  
Gabriel J. Echeverri ◽  
Fabrizio Di Francesco ◽  
...  
Keyword(s):  
Liver Resection ◽  
Liver Injury ◽  
Damage Control ◽  
Length Of Hospital Stay ◽  
Operative Management ◽  
Liver Trauma ◽  
Organ Injury ◽  
Transplant Center ◽  
Liver Injuries ◽  
Mechanism Of Trauma

Complex liver trauma often presents major diagnostic and management problems. Current operative management is mainly centered on packing, damage control, and early utilization of interventional radiology for angiography and embolization. In this retrospective observational study of patients admitted to the Mediterranean Institute for Transplantation and Advanced Specialized Therapies, Palermo, Italy, from 1999 to 2010, we included patients that underwent hepatic resection for complex liver injuries (grade I to Vaccording to the American Association for the Surgery of Trauma-Organ Injury Scale). Age, gender, mechanism of trauma, type of resection, surgical complications, length of hospital stay, and mortality were the variables analyzed. A total of 53 adult patients were admitted with liver injury and 29 underwent surgical treatment; the median age was 26.7 years. Mechanism was blunt in 52 patients. The overall morbidity was 30 per cent, morbidity related to liver resection was 15.3 per cent. Mortality was 2 per cent in the series of patients undergoing liver resection for complex hepatic injury, whereas in the nonoperative group, morbidity was 17 per cent and mortality 2 per cent. Liver resection should be considered a serious surgical option, as initial or delayed management, in patients with complex liver injury and can be accomplished with low mortality and liver-related morbidity when performed in specialized liver surgery/transplant centers.

scholarly journals Damage Control in Penetrating Liver Trauma: Fear of the Unknown

2020 ◽  
Author(s):  
Carlos Alberto Ordoñez ◽  
Michael Parra ◽  
Mauricio Millan ◽  
Yaset Caicedo ◽  
Monica Guzman ◽  
...  
Keyword(s):  
Damage Control ◽  
Damage Control Surgery ◽  
Operative Management ◽  
Hemodynamic Instability ◽  
Liver Trauma ◽  
Solid Organ ◽  
Severely Injured ◽  
Management Algorithm ◽  
Liver Injuries ◽  
Non Operative Management

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.

scholarly journals Utility of Glissonean Pedicle Transection for Surgical Treatment of Severe Liver Trauma

2017 ◽  
Vol 11 (1) ◽  
pp. 190-200
Author(s):  
Satoshi Koizumi ◽  
Kenta Katsumata ◽  
Tatsunori Ono ◽  
Kouhei Segami ◽  
Hiroyuki Hoshino ◽  
...  
Keyword(s):  
Surgical Treatment ◽  
Damage Control ◽  
Damage Control Surgery ◽  
Liver Trauma ◽  
Control Procedure ◽  
Severe Liver ◽  
Hepatic Hilus ◽  
Initial Strategy ◽  
Glissonean Pedicle ◽  
Definitive Surgery

The most common initial strategy for treatment of severe liver trauma is damage control in which hemostasis is achieved by perihepatic gauze packing and/or vascular embolization. However, we encounter patients in whom this strategy alone is not adequate. We have applied the principles of Glissonean pedicle transection, a technique that was originally devised to ensure safe and quick performance of planned hepatectomy for liver cancer, to 3 cases of severe liver trauma. We performed Glissonean pedicle ligation during damage control surgery in 2 patients and Glissonean pedicle transection during the definitive surgery in 1 patient. We describe the approaches and our experience with them, including operation times and outcomes. From our experience thus far, it seems that 8–12 h after the damage control procedure is appropriate for performing the definitive surgery. Although there are some problems posed by this strategy and cases to which it will not be applicable, the method seems to be particularly useful for cases of severe liver trauma in which the damage is extensive and involves the Glissonean pedicles near the hepatic hilus. We describe our 3 cases in detail and review our experience in light of the available literature.

Management of liver injuries: Predictors for the need of operation and damage control surgery

Injury ◽  
2014 ◽  
Vol 45 (9) ◽  
pp. 1373-1377 ◽  
Author(s):  
Supparerk Prichayudh ◽  
Chayatat Sirinawin ◽  
Suvit Sriussadaporn ◽  
Rattaplee Pak-art ◽  
Kritaya Kritayakirana ◽  
...  
Keyword(s):  
Damage Control ◽  
Damage Control Surgery ◽  
Liver Injuries

scholarly journals Management of complications of first instance of hepatic trauma in a liver surgery unit: Portal vein ligation as a conservative therapeutic strategy

Open Medicine ◽  
2019 ◽  
Vol 14 (1) ◽  
pp. 376-383 ◽  
Author(s):  
Aldo Rocca ◽  
Enrico Andolfi ◽  
Anna Ginevra Immacolata Zamboli ◽  
Giuseppe Surfaro ◽  
Domenico Tafuri ◽  
...  
Keyword(s):  
Portal Vein ◽  
Damage Control ◽  
Pathological Finding ◽  
Damage Control Surgery ◽  
Liver Trauma ◽  
The Other ◽  
Portal Vein Ligation ◽  
Bleeding Site ◽  
Hepatic Trauma ◽  
Management Of Complications

AbstractBackgroundAccording to the National Trauma Data Bank, the liver, after the spleen, is the first most injured organ in closed abdominal trauma.MethodsFrom June 2010 to December 2015 we observed in our department of Hepato-biliary Surgery and Liver Transplant Unit of the A.O.R.N. A. Cardarelli of Naples 40 patients affected by hepatic trauma. In our retrospective study, we review our experience and propose portal vein ligation (PVL) as a first – line strategy for damage control surgery (DCS) in liver trauma.Results26/40 patients (65%) which received gauze-packing represented our study group. In 10 cases out of 26 patients (38,4%) the abdominal packing was enough to control the damage. In 7 cases (18,4%) we performed a liver resection. In 7 cases, after de-packing, we adopted PVL to achieve DCS. Trans Arterial Embolization was chosen in 6 patients. 2 of them were discharged 14 days later without performing any other procedure.In 3 cases we had to perform a right epatectomy in second instance. Two hepatectomies were due to hemoperitoneum, and the other for coleperitoneum. Two patients were treated in first instance by only doing hemostasis on the bleeding site. We observed 6 patients in first instance. Five of them underwent surgery with hepatic resection and surgical hemostasis of the bleeding site. The other one underwent to conservative management. In summary we performed 15 hepatic resections, 8 of them were right hepatectomies, 1 left hepatectomy, 2 trisegmentectomies V-VI-VII. So in second instance we operated on 10 patients out of 34 (30%).ConclusionsThe improved knowledge of clinical physio-pathology and the improvement of diagnostic and instrumental techniques had a great impact on the prognosis of liver trauma. We think that a rigid diagnostic protocol should be applied as this allows timely pathological finding, and consists of three successive but perfectly integrated steps: 1) patient reception, in close collaboration with the resuscitator; 2) accurate but quick diagnostic framing 3) therapeutic decisional making. Selective portal vein ligation is a well-tolerated and safe manoeuvre, which could be effective, even if not definitive, in treating these subjects. That is why we believe that it can be a choice to keep in mind especially in post-depacking bleeding.

scholarly journals Damage Control Surgery for Hepatocellular Cancer Rupture in an Elderly Patient: Survival and Quality of Life

2015 ◽  
Vol 2015 ◽  
pp. 1-4 ◽  
Author(s):  
Konstantinos Bouliaris ◽  
Grigorios Christodoulidis ◽  
Dimitrios Symeonidis ◽  
Alexandros Diamantis ◽  
Konstantinos Tepetes
Keyword(s):  
Elderly Patient ◽  
Liver Function ◽  
Spontaneous Rupture ◽  
Damage Control ◽  
Correct Diagnosis ◽  
Hypovolemic Shock ◽  
Future Liver Remnant ◽  
Damage Control Surgery ◽  
Liver Trauma ◽  
Liver Remnant

Spontaneous rupture of hepatocellular carcinoma (HCC) is a rare emergency condition with high mortality rate. Successful management depends on patients’ hemodynamic condition upon presentation and comorbidities, correct diagnosis, HCC status, liver function, and future liver remnant, as well as available sources. There is still a debate in the literature concerning the best approach in this devastating complication. Nevertheless, the primary goal should be a definitive bleeding arrest. In most cases, patients with spontaneous rupture of HCC present with hemodynamic instability, due to hemoperitoneum, necessitating an emergency treatment modality. In such cases, transcatheter arterial embolization (TAE) should be the treatment of choice. Emergency liver resection is an option when TAE fails or in cases with preserved liver function and limited tumors. Otherwise, damage control strategies, as in liver trauma, are a reasonable alternative. We report a case of an elderly patient with hemoperitoneum and hypovolemic shock from spontaneous rupture of undiagnosed HCC, who was treated successfully by emergency surgery and damage control approach.

scholarly journals Liver Trauma Management

2021 ◽  
Author(s):  
Henrique A. Wiederkehr ◽  
Julio Wiederkehr ◽  
Barbara A. Wiederkehr ◽  
Lucas M. Sarquis ◽  
Oona T. Daronch ◽  
...  
Keyword(s):  
Damage Control ◽  
Damage Control Surgery ◽  
Liver Trauma ◽  
Hepatic Veins ◽  
Trauma Management ◽  
Conservative Approach ◽  
The Third ◽  
Wide Range ◽  
Polytrauma Patients ◽  
Complex Lesions

Liver trauma is responsible for the majority of penetrating abdominal trauma and is the third most common injury caused by firearms. Presenting a 20% mortality rate, it is an organ with wide and complex vascularization, receiving blood from the hepatic veins and portal vein, as well as from the hepatic arteries. The diagnosis is not always simple in polytrauma patients and contains a wide range of exams such as computerized tomography and diagnostic peritoneal lavage. Treatment depends mostly on a few factors such as the patient’s hemodynamic stability, the degree of injury according to the AAST classification, the resources available, and the surgeon’s expertise. Considering these factors, minor lesions can be treated mostly with a conservative approach in hemodynamically stable patients. Embolization by arteriography has shown good results in major lesions in clinically stable patients as well. On the other hand, more complex lesions associated with hemodynamically unstable patients may indicate damage control surgery applying techniques such as temporary liver packing and clamping the pedicle to restore the hemodynamic status. This chapter aims to describe those techniques and their indications in liver trauma.

scholarly journals Traumatic Intraparenchymal Pseudoaneurysm on Initial Imaging Predicts Injury Progression in Patients with Nonoperative Major Blunt Liver Injury

2017 ◽  
Author(s):  
Duraid Younan ◽  
T. Mark Beasley ◽  
Andrew Papoy ◽  
Geoffrey Douglas ◽  
Patrick Bosarge
Keyword(s):  
Liver Injury ◽  
Ct Scan ◽  
Management Plan ◽  
Liver Trauma ◽  
Imaging Data ◽  
Blunt Liver Injury ◽  
Negative Results ◽  
Liver Injuries ◽  
Injury Progression ◽  
Repeat Imaging

Abstract Objective: Identify factors that would predict which patients would benefit from repeat imaging after major blunt liver injury. Summary of Background Data: Most patients who present with hemodynamic stability and no evidence of peritonitis after blunt liver injury are successfully managed nonoperatively. Little information is available regarding the utility of reimaging major blunt liver injuries for patients who are managed nonoperatively. Methods: A retrospective review of patients admitted to a level I trauma center with major blunt liver injuries (AAST grades 3-5) was conducted. Inclusion criteria were those admitted from July 2012 to June 2014 with blunt liver trauma who survived the first 24 hours and underwent repeat imaging. Data included demographics, procedures performed and computerized tomography (CT) scan findings. Findings on the second CT scan were categorized as Unchanged, Worse, Improved, or Negative. Results: 128 patients had blunt major liver injuries; 66 patients underwent repeat imaging. The mean time to repeat CT was 1.95 days. On repeat CT 47 were "Unchanged", 3 "Worse", 14 "Improved" and 2 "Negative". Three patients underwent angiography. One required embolization of a pseudoaneurysm. In 63 patients (95%), the second CT did not change the management plan. The presence of a pseudoaneurysm was significantly related to a worsening of the second CT (p=0.0475). Patients with admission hematocrit (Hct) below 32% were more likely to have a worsened second CT (p=0.0370). Conclusions: A pseudoaneurysm on admission CT and Hct <32% predict major liver injury progression suggesting that routine reimaging is warranted in this group.

scholarly journals Management of Traumatic Liver Injury in a Tertiary Care Hospital in Nepal

2020 ◽  
Vol 17 (4) ◽  
pp. 537-542
Author(s):  
Harish Chandra Neupane ◽  
Kishor Kumar Tamrakar ◽  
Abhishek Bhattrai ◽  
Tseten Yonjen Tamang ◽  
Bishnu Bista ◽  
...  
Keyword(s):  
Liver Injury ◽  
Operative Management ◽  
Treatment Modalities ◽  
Low Grade ◽  
Solid Organ ◽  
Care Hospital ◽  
Liver Injuries ◽  
Group A ◽  
Group B ◽  
Isolated Liver

Background: The liver is most frequently injured solid organ in abdominal trauma. The non-operative management is the standard treatment for hemodynamically stable patients. This study analyse the epidemiological aspects, injury patterns, treatment modalities and outcome in patients with liver injuries only and associated injuries outside the liver.Methods: This was a retrospective study in patients with liver injuries admitted from 1st March 2014 to 31st January 2019 at Chitwan Medical College and Hospital, Nepal. The patients were divided into two groups. Group A consisted of isolated liver injury and Group B liver injury with associated injury of other organs. Data were analysed by using descriptive statistics and Mann-Whitney U test.Results: A total of 61 patients were admitted with liver injury. There were 18 (29.5 %) patients with liver injury alone (group A) and 43 (70.5 %)liver injury associated with other organs (group B). Low grade liver injuries were 48 (78.7 %) and high grade 13 (21.3 %). The operative management was done for one liver injury with biliary peritonitis in group A. In group B, 16 patients required laparotomy and operative management for associated abdomen injuries.Conclusions: Non-operative treatment modality in hemodynamically stable patients with isolated liver injuries was safe and effective.Keywords: Liver injury; management; scoring; trauma.

scholarly journals Damage Control Surgery for Liver Trauma

2020 ◽  
Author(s):  
Ioannis A. Ziogas ◽  
Ioannis Katsaros ◽  
Georgios Tsoulfas
Keyword(s):  
Damage Control ◽  
Damage Control Surgery ◽  
Liver Trauma
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