Fractured parenchyma can be reapproximated with suture hepatorrhaphy. The hepatic wound should be explored, and any injured bile duct radicals should be identified and ligated with suture or clips. Similarly, damaged blood vessels can be identified and ligated or clipped. For grade II or III injuries, chromic suture on a or blunt needle can be used to approximate the laceration.
For deeper lacerations, omentum can be packed into the injured parenchyma and sutured into place with simple sutures. Commercial hemostatic agents can also be placed on injured parenchyma to help maintain hemostasis.
Acute Abdomen - Role of CT in Trauma
Closed suction drains can be left into place at the discretion of the surgeon to control potential bile leak or hepatic necrosis. Other therapies can be used to treat patients with traumatic liver injuries. Endoscopic retrograde cholangiopancreatography ERCP can be used to identify and treat bile duct injuries, whether done pre- or post-operatively.
Stents can be placed at the time of ERCP to help treat bile duct lacerations. In addition, bile duct stents can be placed to decrease hepatic parenchymal bile leak and facilitate healing of injured bile ducts. Interventional radiology IR can also be used as an adjunct for hepatic trauma. Bilomas or hepatic abscesses can develop as a result of traumatic injury or as a complication of angioembolization and hepatic necrosis.
Closed suction drains can be placed by IR to drain infections or bilious fluid collections. Clinicians should be aware of several complications that can develop after liver trauma.
Liver Injury Grading Scale - ANZ Journal of Surgery
Also, hepatic abscesses can develop after hepatic artery ligation or angioembolization. Hepatic necrosis occurs commonly after hepatic injury and is most likely to occur in patients undergoing angioembolization. These patients can present with fever and leukocytosis. Patients with mild symptoms can be treated supportively with IV fluids while those with more serious inflammatory responses may require intervention in the form of IR placed drains or in more serious cases, repeated operative debridement or formal hepatic resection.
Another rare complication of hepatic trauma is arterio-biliary or porto-biliary fistula that results in hemobilia. Hemobilia can result in clot and obstruction of the biliary tree.
- Injury Scoring Scale;
- Eine Frage von Glück oder Zufall: Roman (German Edition)?
- The Sacred Place: A Novel.
Brisk bleeds can present similarly to classic GI bleed with the addition of jaundice and upper abdominal pain. Hemobilia can be treated with selective angioembolization. More severe cases may necessitate operative intervention with ligation of the feeding vessel or anatomic liver resection.
To access free multiple choice questions on this topic, click here. This book is distributed under the terms of the Creative Commons Attribution 4. Turn recording back on. National Center for Biotechnology Information , U. StatPearls [Internet]. Search term. Affiliations 1 Tulane University School of Medicine.
Introduction The liver is the most regularly injured organ in blunt abdominal trauma. Etiology A traumatic liver injury is common in both blunt and penetrating abdominal injuries. History and Physical Care of the patient with hepatic injury often begins in the trauma bay.
AAST Liver Injury Scale 2018 revision
Evaluation Laboratory Evaluation Trauma patients with the appropriate mechanism of injury that are seen in the trauma bay should receive a standard set of laboratory tests. Radiologic Evaluation Radiologic assessment can also begin in the trauma bay with focused assessment with sonography for trauma FAST exam. Angiographic Embolization Angiography with selective embolization is an effective treatment for patients undergoing non-operative therapy of bleeding liver injuries, especially those with blunt hepatic injuries.
Operative Management Hemodynamically unstable patients, not responsive to resuscitation, should go directly from the trauma bay to the operating room for laparotomy. Adjunct Treatments Other therapies can be used to treat patients with traumatic liver injuries. Complications Clinicians should be aware of several complications that can develop after liver trauma. Questions To access free multiple choice questions on this topic, click here. References 1. Organ injury scaling update: Spleen, liver, and kidney.
J Trauma Acute Care Surg. Significant trends in the treatment of hepatic trauma. Experience with injuries. Hepatic Trauma. Eur J Trauma Emerg Surg. Management of liver trauma. World J Surg. The accuracy of focused assessment with sonography in trauma FAST in blunt trauma patients: experience of an Australian major trauma service. J Trauma. Blunt liver injuries in polytrauma: results from a cohort study with the regular use of whole-body helical computed tomography. Organ injury scaling: spleen and liver revision. Nonoperative management of blunt hepatic injury: an Eastern Association for the Surgery of Trauma practice management guideline.
Interventional techniques are useful adjuncts in nonoperative management of hepatic injuries. Briggs A, Askari R.
- Le donne guanto Patterns per uncinetto (Italian Edition).
- Liver injury;
- Sexy Collections Maiko 33 (Japanese Edition).
- Register for a free account?
Damage control resuscitation. Int J Surg. Surgical management and outcome of blunt major liver injuries: experience of damage control laparotomy with perihepatic packing in one trauma centre. Hepatic artery pseudoaneurysm, bronchobiliary fistula in a patient with liver trauma. BMC Surg.
Liver Trauma. In: StatPearls [Internet]. In this Page. Related information. Similar articles in PubMed. Epub Sep 4. Review Non-operative management versus operative management in high-grade blunt hepatic injury. Cochrane Database Syst Rev. Epub Aug Non-operative management of isolated solid organ injuries due to blunt abdominal trauma in children: a fifteen-year experience. Eur J Pediatr Surg. Review [Abdominal trauma]. Acta Chir Orthop Traumatol Cech. Recent Activity.
Clear Turn Off Turn On. Support Center Support Center. The ObGyn should have performed a more extensive check to ensure that no perforation had occurred. There was no negligence. He performed a modified radical hysterectomy with pelvic node dissection and lymphadenectomy. A Pfannenstiel incision was used, and the procedure involved removal of the uterus, cervix, upper quarter of the vagina, pelvic lymph nodes, and surrounding tissue.
Surgery lasted longer than 5 hours. The next day, the patient reported pain, burning, tingling, and numbness in her left thigh, which was eventually diagnosed as lateral femoral cutaneous neuropathy. This condition did not resolve. He allowed the retractor blades to press on the psoas muscles, thus injuring the lateral femoral cutaneous nerve. The surgeon also used his hands to determine that the retractors were properly positioned.
The child was born 7 months later with Down syndrome. If she had been informed, she would have terminated the pregnancy.
Function of the Liver
Amniocentesis was recommended, but the mother had declined. Skip to main content. Medical Verdicts. Lethal liver injury blamed on birth trauma OBG Manag. Lethal liver injury blamed on birth trauma.