Management of liver trauma in Kuwait

Affiliations

01 January 2014

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doi: 10.1159/000358126


Abstract

Objectives: The aim of this study was to introduce the concept of non-operative management (NOM) for blunt liver trauma by establishing a protocol and a prospective Liver Trauma Registry in Kuwait.

Subjects and methods: A prospective Liver Trauma Registry was started in 4 hospitals and it included 117 patients who had sustained blunt liver trauma (94 men and 23 women). Unstable patients were taken to surgery while stable patients were managed conservatively regardless of the grade of liver injury. High-grade (III-VI) liver injuries were managed in collaboration with the liver surgery specialist.

Results: The mean age of the 117 patients was 29.02 ± 11.18 years (range 7-63). NOM was successful in 94 (96%) patients and failed in 4 (4%) (these 4 then underwent successful surgery). Nineteen (16.2%) were unstable and underwent surgery immediately; 15 (79%) of them survived (they had had grade III-V injuries) and 4 died (2 with grade V injuries and 2 with grade VI injuries). Perihepatic packing was necessary in 8/19 (42%) patients. The overall mortality was 3.4% (4/117).

Conclusions: This study showed that NOM was successful in a majority of patients with blunt liver trauma. In addition, it confirmed that the magnitude of liver injury and haemoperitoneum did not preclude NOM as long as the patient was haemodynamically stable.


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References

  1.  
    1. 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. - PMC - PubMed
  2.  
    1. Kozar RA, Moore FA, Moore EE, et al. Western Trauma Association critical decisions in trauma: nonoperative management of adult blunt hepatic trauma. J Trauma. 2009;67:1144–1149. - PubMed
  3.  
    1. Malhotra AK, Fabian TC, Croce MA, et al. Blunt hepatic injury: a paradigm shift from operative to nonoperative management in the 1990s. Ann Surg. 2000;231:804–813. - PMC - PubMed
  4.  
    1. Velmahos GC, Toutouzas KG, Radin R, et al. Nonoperative treatment of blunt injury to solid abdominal organs. A prospective study. Arch Surg. 2003;138:844–851. - PubMed
  5.  
    1. Moore EE, Cogbill TH, Jurkovich GJ, et al. Organ injury scaling: spleen and liver (1994 revision) J Trauma. 1995;38:323–324. - PubMed
  6.  
    1. Kozar RA, Moore JB, Niles SE, et al. Complications of nonoperative management of high-grade hepatic injuries. J Trauma. 2005;59:1066–1071. - PubMed
  7.  
    1. Leppäniemi AK, Mentula PJ, Streng MH, et al. Severe hepatic trauma: nonoperative management, definitive repair, or damage control surgery? World J Surg. 2011;35:2643–2649. - PubMed
  8.  
    1. Butt MU, Zacharias N, Velmahos GC. Penetrating abdominal injuries: management controversies. Scand J Trauma Resusc Emerg Med. 2009;17:19. - PMC - PubMed
  9.  
    1. Zafar SN, Rushing A, Haut ER, et al. Outcome of selective non-operative management of abdominal injuries from the North American National Trauma Database. Br J Surg. 2011;99(suppl 1):155–165. - PubMed
  10.  
    1. Schnüriger B, Inderbitzin D, Schafer M, et al. Concomitant injuries are an important determinant of outcome of high-grade blunt hepatic trauma. Br J Surg. 2009;96:104–110. - PubMed
  11.  
    1. Scollay JM, Beard D, Smith R, et al. Eleven years of liver trauma: the Scottish experience. World J Surg. 2005;29:744–749. - PubMed
  12.  
    1. Parks N, Davis J, Forman D, et al. Observation for nonoperative management of blunt liver injuries: how long is long enough? J Trauma. 2011;70:626–629. - PubMed
  13.  
    1. Clemente N, Di Saverio S, Giorgini E, et al. Management and outcome of 308 cases of liver trauma in a Bologna trauma center in 10 years. Ann Ital Chir. 2011;82:351–359. - PubMed
  14.  
    1. Ramkumar K, Perera MT, Marudanayagam R, et al. A reaudit of specialist managed liver trauma after establishment of regional referral and management guidelines. J Trauma. 2010;68:84–89. - PubMed
  15.  
    1. Shapiro MB, Nance ML, Schiller HJ, et al. Nonoperative management of solid abdominal organ injuries from blunt trauma: impact of neurologic impairment. Am Surg. 2001;67:793–796. - PubMed
  16.  
    1. van der Vlies CH, Olthof DC, Gaakeer M, et al. Changing pattern in diagnostic strategies and the treatment of blunt injury to solid abdominal organs. Int J Emerg Med. 2011;4:47. - PMC - PubMed
  17.  
    1. Watts DD, Fakhry SM, EAST Multi-Institutional Hollow Viscus Injury Research Group Incidence of hollow viscus injury in blunt trauma: an analysis from 275,557 trauma admissions from the East Multi-Institutional Trial. J Trauma. 2003;54:289–294. - PubMed
  18.  
    1. Ochai T, Igari K, Yagi M, et al. Treatment strategy for blunt hepatic trauma: analysis of 183 consecutive cases. Hepatogastroenterology. 2011;58:1312–1315. - PubMed
  19.  
    1. Asensio JA, Roldán G, Petrone P, et al. Operative management and outcomes in 103 AAST-OIS grades IV and V complex hepatic injuries: trauma surgeons still need to operate but angioembolization helps. J Trauma. 2003;54:647–653. - PubMed
  20.  
    1. Moore AFK, Hargest R, Martin M, et al. Intra-abdominal hypertension and abdominal compartment syndrome. Br J Surg. 2004;91:1102–1110. - PubMed
  21.  
    1. Dabbs DN, Stein DM, Scalea TM. Major hepatic necrosis: a common complication after angioembolization for treatment of high-grade liver injuries. J Trauma. 2009;66:621–627. - PubMed
  22.  
    1. Letoublon C, Morra I, Chen Y, et al. Hepatic arterial embolization in the management of blunt hepatic trauma: indications and complications. J Trauma. 2011;70:1032–1037. - PubMed
  23.  
    1. Di Saverio S, Moore EE, Tugnoli G, et al. Non-operative management of liver and spleen traumatic injuries: a giant with clay feet. World J Emerg Surg. 2012;7:3. - PMC - PubMed
  24.  
    1. Yuan KC, Wong YC, Lin BC, et al. Negative catheter angiography after vascular contrast extravasations on computed tomography in blunt torso trauma: an experience review of a clinical dilemma. Scand J Trauma. 2012;20:46–53. - PMC - PubMed
  25.  
    1. Tsugawa K, Koyanagi N, Hashizume M, et al. Anatomic resection for severe blunt liver trauma in 100 patients: significant differences between young and elderly. World J Surg. 2002;26:544–549. - PubMed
  26.  
    1. Cogbill TH, Moore EE, Jurkovich GJ, et al. Severe hepatic trauma: a multi-center experience with 1,335 liver injuries. J Trauma. 1988;28:1433–1438. - PubMed
  27.  
    1. Kudsk KA, Sheldon GF, Lim RC., Jr Atriocaval shunting (ACS) after trauma. J Trauma. 1982;22:81–85. - PubMed
  28.  
    1. Burch JM, Feliciano DV, Mattox KL. The ateriocaval shunt. Facts and fiction. Ann Surg. 1988;207:555–568. - PMC - PubMed
  29.  
    1. Nicol AJ, Hommes M, Primrose R, et al. Packing for control of hemorrhage in major liver trauma. World J Surg. 2007;31:569–574. - PubMed
  30.  
    1. Alllard MA, Dondero F, Sommacale D, et al. Liver packing during elective surgery: An option that can be considered. World J Surg. 2011;35:2493–2498. - PubMed