Pietro Padalino1,2,3, Fabio Bomben4, Osvaldo Chiara5, Gianguido Montagnolo4, Aldo Marini4, Mauro Zago6, Paola Rebora7. 1. Department of General Surgery and Emergency Surgery, University of Milan - Bicocca, Milan, Italy. pietro.pad@tiscali.it. 2. Ospedale San Gerardo - Monza, Monza, Italy. pietro.pad@tiscali.it. 3. Department of General Surgery and Emergency Surgery, University of Milan - Bicocca, Via Pergolesi 33, 20052, Milan, Italy. pietro.pad@tiscali.it. 4. Department of Emergency Surgery and Trauma, IRCCS Ospedale Maggiore, Milan, Italy. 5. Department of Surgery and Trauma, Ospedale Niguarda, Milan, Italy. 6. Department of Mini-Invasive Surgery, Clinica Humanitas, Rozzano, Italy. 7. Department of Clinical Medicine and Prevention, University of Milan - Bicocca, Milan, Italy.
Abstract
BACKGROUND: Non-operative management of patients with blunt liver trauma has become the standard of care. Usually after initial computed tomography (CT) evaluation and a short-term intra-hospital instrumental and clinical monitoring, no other imaging assessment is routinely requested. A restriction of physical activities for a few (unfixed number of) months is the most common recommendation. A few studies investigated the re-establishment of normal hepatic parenchymal architecture, but there is no evidence of the correct length of time for a certain resumption to normal life. To understand the progression of traumatic liver damage and the time course of healing, and to indicate the correct spontaneous recovery time, a long-term sonographic followup was done. METHODS: Forty-four patients with blunt non-operatively managed hepatic injury were selected by a retrospective review of a prospectively collected database. At admission, in accordance with the American Association for the Surgery of Trauma (AAST), all lesions were evaluated by CT and graded by the Organ Injury Scale (OIS). The progression of liver repair was followed by ultrasonographic (US) controls on days 3, 5, 10, 15, 30, and 60, and monthly up to a complete clinical recovery and sonographic disappearance of lesions. RESULTS: One OIS grade I, 20 grade II, 13 grade III, eight grade IV, and two grade V hepatic injuries were included in the study. Forty patients were monitored until liver normalization by 218 US examinations. The median time for liver repair in OIS grades II, III, IV, and V was 30, 63, 62, and 118 days, respectively, and 75% of the patients recovered in 60, 80, and 98 days in the II, III, and IV classes, respectively. CONCLUSION: In our experience, a long time variability for spontaneous liver repair after blunt trauma and non-operative treatment was found, but a parenchymal US normalization was evidenced in a median time shorter than that usually reported in the literature.
BACKGROUND: Non-operative management of patients with blunt liver trauma has become the standard of care. Usually after initial computed tomography (CT) evaluation and a short-term intra-hospital instrumental and clinical monitoring, no other imaging assessment is routinely requested. A restriction of physical activities for a few (unfixed number of) months is the most common recommendation. A few studies investigated the re-establishment of normal hepatic parenchymal architecture, but there is no evidence of the correct length of time for a certain resumption to normal life. To understand the progression of traumatic liver damage and the time course of healing, and to indicate the correct spontaneous recovery time, a long-term sonographic followup was done. METHODS: Forty-four patients with blunt non-operatively managed hepatic injury were selected by a retrospective review of a prospectively collected database. At admission, in accordance with the American Association for the Surgery of Trauma (AAST), all lesions were evaluated by CT and graded by the Organ Injury Scale (OIS). The progression of liver repair was followed by ultrasonographic (US) controls on days 3, 5, 10, 15, 30, and 60, and monthly up to a complete clinical recovery and sonographic disappearance of lesions. RESULTS: One OIS grade I, 20 grade II, 13 grade III, eight grade IV, and two grade V hepatic injuries were included in the study. Forty patients were monitored until liver normalization by 218 US examinations. The median time for liver repair in OIS grades II, III, IV, and V was 30, 63, 62, and 118 days, respectively, and 75% of the patients recovered in 60, 80, and 98 days in the II, III, and IV classes, respectively. CONCLUSION: In our experience, a long time variability for spontaneous liver repair after blunt trauma and non-operative treatment was found, but a parenchymal US normalization was evidenced in a median time shorter than that usually reported in the literature.
Authors: M Zago; I Martinez Casas; J Pereira; D Mariani; A R Silva; A Casamassima; E Barbosa; F Ferreira; M Ruesseler; G A Bass; L Ponchietti; F Butti; M Marconi; L F Pinheiro Journal: Eur J Trauma Emerg Surg Date: 2016-03-17 Impact factor: 3.693