Non-Operative Management of Blunt Liver Trauma: Safety, Efficacy and Complications of a Standardized Treatment Protocol
| Autor: | Festa P, Maurizio De Palma, Giuseppe Noschese, Maurizio Castriconi, Antonio Brillantino, Luigia Romano, Fabio Corvino, Arianna Mottola, Santolo Del Giudice, Mariano Fortunato Armellino, Raffaella Niola, Francesca Iacobellis, Michele Lanza, Ciro Acampora |
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| Rok vydání: | 2019 |
| Předmět: |
medicine.medical_specialty
Treatment protocol Nonoperative management medicine.medical_treatment Non-operative management Liver injury 030218 nuclear medicine & medical imaging 03 medical and health sciences Hemodynamically stable 0302 clinical medicine Blunt Angioembolization medicine Embolization business.industry Mortality rate lcsh:Medical emergencies. Critical care. Intensive care. First aid 030208 emergency & critical care medicine lcsh:RC86-88.9 medicine.disease Surgery Hepatic trauma Blunt trauma Emergency Medicine Original Article business |
| Zdroj: | Bulletin of Emergency & Trauma Bulletin of Emergency and Trauma, Vol 7, Iss Issue 1, Pp 49-54 (2019) |
| ISSN: | 2322-2522 |
| Popis: | Objective: To evaluate the safety and effectiveness of NOM (nonoperative management) in the treatment of blunt liver trauma, following a standardized treatment protocol. Methods: All the hemodynamically stable patients with computed tomography (CT) diagnosis of blunt liver trauma underwent NOM. It included strict clinical and laboratory observation, 48-72h contrast enhanced ultrasonography (CEUS) or CT follow-up, a primary angioembolization in case of admission CT evidence of vascular injuries and a secondary angioembolization in presence of vascular injuries signs at follow-up CEUS. Results: 181 patients (85.4%) [55 (30.4%) women and 126 (69.6%) men, median age 39 (range 14–71)] were included. Of these, 63 patients (34.8%) had grade I, 48 patients (26.5%) grade II, 39 patients (21.5%) grade III, 21 patients (11.6%) grade IV and 10 patients (5.5%) grade V liver injuries. The overall success rate of NOM was 96.7% (175/181). There was not significant difference in the success rate between the patients with different liver injuries grade. Morbidity rate was 7.4% (13/175). Major complications (2 bilomas, 1 liver hematoma and 2 liver abscesses) were successfully treated by CEUS or CT guided drainage. Eighteen (18/181) patients (9.9%) underwent angioembolization with successful results. Conclusion: Nonoperative management of blunt liver trauma represents a safe and effective treatment for both minor and severe injuries, achieving an high success rate and an acceptable morbidity rate. The angiographic study with embolization, although required only in selected cases of vascular injuries, represents a fundamental therapeutic option in a significant percentage of patients. |
| Databáze: | OpenAIRE |
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