L Barbier1, M Calmels2, M Lagadec3, T Gauss4, P-S Abback4, F Cauchy2, M Ronot3, O Soubrane2, C Paugam-Burtz4. 1. HPB Surgery, hôpital Beaujon, université Paris 7 Diderot, DHU Unity, France; Department of Digestive Surgery, hôpital Trousseau, université Rabelais, Tours, FHU SUPORT, France. Electronic address: louisebarbier@hotmail.fr. 2. HPB Surgery, hôpital Beaujon, université Paris 7 Diderot, DHU Unity, France. 3. Radiology, hôpital Beaujon, université Paris 7 Diderot, DHU Unity, France. 4. Department of Anesthesiology and Critical Care, hôpital Beaujon, université Paris 7 Diderot, DHU Unity, France.
Abstract
AIM: To describe the management of blunt liver injury and to study the potential relation between delayed complications, type of trauma mechanisms and liver lesions. PATIENTS AND METHODS: This is a retrospective single center study including 116 consecutive patients admitted with blunt liver injury between 2007 and 2015. RESULTS: Initial CT-scan identified an active bleeding in 33 (28%) patients. AAST (American Association for the Surgery of Trauma) grade was 1 to 3 in 82 (71%) patients and equal to 5 in 15 (13%) patients. Eighty (69%) patients had NOM, with a success rate of 96%. Other abdominal organ lesions were associated to invasive initial management. A follow-up CT-scan was useful to detect hepatic and extra-hepatic complications (46 complications in 80 patients), even without clinical or biological abnormalities. Subsequent hepatic complications such as bleeding, pseudo aneurysms, biloma and biliary peritonitis developed in 15 patients and were associated with the severity of blunt liver injury according to AAST classification (3.7±1.0 vs. 3.0±1.1, P=0.010). Total biliary complications occurred in 13 patients and were significantly more frequently observed in patients with injury of central segments 1, 4 and 9 (69% vs. 36%, P=0.033). CONCLUSIONS: Non-operative management is possible in most blunt liver injury with a success rate of 96%. A systematic CT-scan should be advocated during follow-up, especially when AAST grade is equal or superior to 3. Biliary complications should be suspected when lesions involve segments 1, 4 and 9.
AIM: To describe the management of blunt liver injury and to study the potential relation between delayed complications, type of trauma mechanisms and liver lesions. PATIENTS AND METHODS: This is a retrospective single center study including 116 consecutive patients admitted with blunt liver injury between 2007 and 2015. RESULTS: Initial CT-scan identified an active bleeding in 33 (28%) patients. AAST (American Association for the Surgery of Trauma) grade was 1 to 3 in 82 (71%) patients and equal to 5 in 15 (13%) patients. Eighty (69%) patients had NOM, with a success rate of 96%. Other abdominal organ lesions were associated to invasive initial management. A follow-up CT-scan was useful to detect hepatic and extra-hepatic complications (46 complications in 80 patients), even without clinical or biological abnormalities. Subsequent hepatic complications such as bleeding, pseudo aneurysms, biloma and biliary peritonitis developed in 15 patients and were associated with the severity of blunt liver injury according to AAST classification (3.7±1.0 vs. 3.0±1.1, P=0.010). Total biliary complications occurred in 13 patients and were significantly more frequently observed in patients with injury of central segments 1, 4 and 9 (69% vs. 36%, P=0.033). CONCLUSIONS: Non-operative management is possible in most blunt liver injury with a success rate of 96%. A systematic CT-scan should be advocated during follow-up, especially when AAST grade is equal or superior to 3. Biliary complications should be suspected when lesions involve segments 1, 4 and 9.
Authors: Francesca Iacobellis; Mariano Scaglione; Antonio Brillantino; Maria Giuseppina Scuderi; Francesco Giurazza; Roberto Grassi; Giuseppe Noschese; Raffaella Niola; Naail Yarub Sulaiman Al Zuhir; Luigia Romano Journal: Emerg Radiol Date: 2019-08-23
Authors: Armin Edalatpour; Brian T Young; Laura R Brown; Esther S Tseng; Husayn A Ladhani; Nimitt J Patel; Jeffrey A Claridge; Vanessa P Ho Journal: Injury Date: 2020-03-29 Impact factor: 2.586