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European Journal of Trauma and Emergency Surgery

Erschienen in:

01.06.2015 | Review Article

Management of blunt liver injury: what is new?

verfasst von: J. Ward, L. Alarcon, A. B. Peitzman

Erschienen in: European Journal of Trauma and Emergency Surgery | Ausgabe 3/2015

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Abstract

Nonoperative management has become the surgical treatment of choice in the hemodynamically stable patient with blunt hepatic trauma. The increased use and success of nonoperative management have been facilitated by the development of increasingly higher resolution computed tomography imaging, improved management of physiology and resuscitation (damage control), and routine availability of interventional procedures such as angiography and embolization, image-guided percutaneous drainage, and endoscopy. On the other hand, recognition of the patient who should proceed to immediate laparotomy is of utmost importance. A systematic and logical approach to the control of hemorrhage is required in the operating room. Thorough knowledge of the anatomy and surgical techniques, such as perihepatic packing, effective Pringle maneuver, hepatic mobilization, infrahepatic and suprahepatic control of the IVC, and stapled hepatectomy, is essential.

Matthes G, Stengel D, Seifert J, Rademacher G, Mutze S, Ekkernkamp A. Blunt liver injuries in polytrauma: results from a cohort study with the regular use of whole-body helical computed tomography. World J Surg. 2003;27(10):1124–30. doi:10.1007/s00268-003-6981-0.PubMedCrossRef

Lee SK, Carrillo EH. Advances and changes in the management of liver injuries. Am Surg. 2007;73(3):201–6.PubMed

Malhotra AK, Fabian TC, Croce MA, Gavin TJ, Kudsk KA, Minard G, et al. Blunt hepatic injury: a paradigm shift from operative to nonoperative management in the 1990s. Ann Surg. 2000;231(6):804–13.PubMedCentralPubMedCrossRef

Velmahos GC, Toutouzas KG, Radin R, Chan L, Demetriades D. Nonoperative treatment of blunt injury to solid abdominal organs: a prospective study. Arch Surg. 2003;138(8):844–51. doi:10.1001/archsurg.138.8.844.PubMedCrossRef

Kozar RA, Moore FA, Cothren CC, Moore EE, Sena M, Bulger EM, et al. Risk factors for hepatic morbidity following nonoperative management: multicenter study. Arch Surg. 2006;141(5):451–8. doi:10.1001/archsurg.141.5.451 (discussion 8–9).PubMedCrossRef

Peitzman AB, Marsh JW. Advanced operative techniques in the management of complex liver injury. J Trauma Acute Care Surg. 2012;73(3):765–70. doi:10.1097/TA.0b013e318265cef5.PubMedCrossRef

Polanco P, Leon S, Pineda J, Puyana JC, Ochoa JB, Alarcon L, et al. Hepatic resection in the management of complex injury to the liver. J Trauma. 2008;65(6):1264–9. doi:10.1097/TA.0b013e3181904749 (discussion 9–70).PubMedCrossRef

Becker CD, Mentha G, Terrier F. Blunt abdominal trauma in adults: role of CT in the diagnosis and management of visceral injuries. Part 1: liver and spleen. Eur Radiol. 1998;8(4):553–62.PubMedCrossRef

Ochsner MG. Factors of failure for nonoperative management of blunt liver and splenic injuries. World J Surg. 2001;25(11):1393–6.PubMed

10.

Scalea TM, Rodriguez A, Chiu WC, Brenneman FD, Fallon WF Jr, Kato K, et al. Focused assessment with sonography for trauma (FAST): results from an international consensus conference. J Trauma. 1999;46(3):466–72.PubMedCrossRef

11.

Sirlin CB, Brown MA, Andrade-Barreto OA, Deutsch R, Fortlage DA, Hoyt DB, et al. Blunt abdominal trauma: clinical value of negative screening US scans. Radiology. 2004;230(3):661–8. doi:10.1148/radiol.2303021707.PubMedCrossRef

12.

Wallis A, Kelly MD, Jones L. Angiography and embolisation for solid abdominal organ injury in adults—a current perspective. World J Emerg Surg. 2010;5:18. doi:10.1186/1749-7922-5-18.PubMedCentralPubMedCrossRef

13.

Kozar RA, Moore FA, Moore EE, West M, Cocanour CS, Davis J, et al. Western Trauma Association critical decisions in trauma: nonoperative management of adult blunt hepatic trauma. J Trauma. 2009;67(6):1144–8. doi:10.1097/TA.0b013e3181ba361f (discussion 8–9).PubMedCrossRef

14.

Moore EE, Cogbill TH, Jurkovich GJ, Shackford SR, Malangoni MA, Champion HR. Organ injury scaling: spleen and liver (1994 revision). J Trauma. 1995;38(3):323–4.PubMedCrossRef

15.

Poletti PA, Mirvis SE, Shanmuganathan K, Killeen KL, Coldwell D. CT criteria for management of blunt liver trauma: correlation with angiographic and surgical findings. Radiology. 2000;216(2):418–27. doi:10.1148/radiology.216.2.r00au44418.PubMedCrossRef

16.

Yoon W, Jeong YY, Kim JK, Seo JJ, Lim HS, Shin SS, et al. CT in blunt liver trauma. Radiographics. 2005;25(1):87–104. doi:10.1148/rg.251045079.PubMedCrossRef

17.

Taourel P, Vernhet H, Suau A, Granier C, Lopez FM, Aufort S. Vascular emergencies in liver trauma. Eur J Radiol. 2007;64(1):73–82. doi:10.1016/j.ejrad.2007.07.013.PubMedCrossRef

18.

Nance ML, Peden GW, Shapiro MB, Kauder DR, Rotondo MF, Schwab CW. Solid viscus injury predicts major hollow viscus injury in blunt abdominal trauma. J Trauma. 1997;43(4):618–22 (discussion 22–23).PubMedCrossRef

19.

Bilgic I, Gelecek S, Akgun AE, Ozmen MM. Predictive value of liver transaminases levels in abdominal trauma. Am J Emerg Med. 2014;32(7):705–8. doi:10.1016/j.ajem.2014.03.052.PubMedCrossRef

20.

Tan KK, Bang SL, Vijayan A, Chiu MT. Hepatic enzymes have a role in the diagnosis of hepatic injury after blunt abdominal trauma. Injury. 2009;40(9):978–83. doi:10.1016/j.injury.2009.02.023.PubMedCrossRef

21.

Tian Z, Liu H, Su X, Fang Z, Dong Z, Yu C, et al. Role of elevated liver transaminase levels in the diagnosis of liver injury after blunt abdominal trauma. Exp Ther Med. 2012;4(2):255–60. doi:10.3892/etm.2012.575.PubMedCentralPubMed

22.

Christmas AB, Wilson AK, Manning B, Franklin GA, Miller FB, Richardson JD, et al. Selective management of blunt hepatic injuries including nonoperative management is a safe and effective strategy. Surgery. 2005;138(4):606–10. doi:10.1016/j.surg.2005.07.018 (discussion 10–11).PubMedCrossRef

23.

Feliciano DV. Continuing evolution in the approach to severe liver trauma. Ann Surg. 1992;216(5):521–3.PubMedCentralPubMedCrossRef

24.

Pachter HL, Knudson MM, Esrig B, Ross S, Hoyt D, Cogbill T, et al. Status of nonoperative management of blunt hepatic injuries in 1995: a multicenter experience with 404 patients. J Trauma. 1996;40(1):31–8.PubMedCrossRef

25.

Badger SA, Barclay R, Campbell P, Mole DJ, Diamond T. Management of liver trauma. World J Surg. 2009;33(12):2522–37. doi:10.1007/s00268-009-0215-z.PubMedCrossRef

26.

David Richardson J, Franklin GA, Lukan JK, Carrillo EH, Spain DA, Miller FB, et al. Evolution in the management of hepatic trauma: a 25-year perspective. Ann Surg. 2000;232(3):324–30.PubMedCentralPubMedCrossRef

27.

Pachter HL. Prometheus bound: evolution in the management of hepatic trauma–from myth to reality. J Trauma Acute Care Surg. 2012;72(2):321–9. doi:10.1097/TA.0b013e31824b15a7.PubMed

28.

Parks NA, Davis JW, Forman D, Lemaster D. Observation for nonoperative management of blunt liver injuries: how long is long enough? J Trauma. 2011;70(3):626–9. doi:10.1097/TA.0b013e31820d1c69.PubMedCrossRef

29.

Piper GL, Peitzman AB. Current management of hepatic trauma. Surg Clin North Am. 2010;90(4):775–85. doi:10.1016/j.suc.2010.04.009.PubMedCrossRef

30.

Raza M, Abbas Y, Devi V, Prasad KV, Rizk KN, Nair PP. Non operative management of abdominal trauma—a 10 years review. World J Emerg Surg. 2013;8:14. doi:10.1186/1749-7922-8-14.PubMedCentralPubMedCrossRef

31.

Stassen NA, Bhullar I, Cheng JD, Crandall M, Friese R, Guillamondegui O, et al. Nonoperative management of blunt hepatic injury: an Eastern Association for the Surgery of Trauma practice management guideline. J Trauma Acute Care Surg. 2012;73(5 Suppl 4):S288–93. doi:10.1097/TA.0b013e318270160d.PubMedCrossRef

32.

Leppaniemi AK, Mentula PJ, Streng MH, Koivikko MP, Handolin LE. Severe hepatic trauma: nonoperative management, definitive repair, or damage control surgery? World J Surg. 2011;35(12):2643–9. doi:10.1007/s00268-011-1309-y.PubMedCrossRef

33.

van der Wilden GM, Velmahos GC, Emhoff T, Brancato S, Adams C, Georgakis G, et al. Successful nonoperative management of the most severe blunt liver injuries: a multicenter study of the research consortium of new England centers for trauma. Arch Surg. 2012;147(5):423–8. doi:10.1001/archsurg.2012.147.PubMed

34.

Velmahos GC, Toutouzas K, Radin R, Chan L, Rhee P, Tillou A, et al. High success with nonoperative management of blunt hepatic trauma: the liver is a sturdy organ. Arch Surg. 2003;138(5):475–80. doi:10.1001/archsurg.138.5.475 (discussion 80–81).PubMedCrossRef

35.

Tinkoff G, Esposito TJ, Reed J, Kilgo P, Fildes J, Pasquale M, et al. American Association for the Surgery of Trauma Organ Injury Scale I: spleen, liver, and kidney, validation based on the National Trauma Data Bank. J Am Coll Surg. 2008;207(5):646–55. doi:10.1016/j.jamcollsurg.2008.06.342.PubMedCrossRef

36.

Polanco PM, Brown JB, Puyana JC, Billiar TR, Peitzman AB, Sperry JL. The swinging pendulum: a national perspective of nonoperative management in severe blunt liver injury. J Trauma Acute Care Surg. 2013;75(4):590–5. doi:10.1097/TA.0b013e3182a53a3e.PubMedCrossRef

37.

Carrillo EH, Spain DA, Wohltmann CD, Schmieg RE, Boaz PW, Miller FB, et al. Interventional techniques are useful adjuncts in nonoperative management of hepatic injuries. J Trauma. 1999;46(4):619–22 (discussion 22–24).PubMedCrossRef

38.

Goldman R, Zilkoski M, Mullins R, Mayberry J, Deveney C, Trunkey D. Delayed celiotomy for the treatment of bile leak, compartment syndrome, and other hazards of nonoperative management of blunt liver injury. Am J Surg. 2003;185(5):492–7.PubMedCrossRef

39.

Fang JF, Chen RJ, Wong YC, Lin BC, Hsu YB, Kao JL, et al. Pooling of contrast material on computed tomography mandates aggressive management of blunt hepatic injury. Am J Surg. 1998;176(4):315–9.PubMedCrossRef

40.

Fang JF, Wong YC, Lin BC, Hsu YP, Chen MF. The CT risk factors for the need of operative treatment in initially hemodynamically stable patients after blunt hepatic trauma. J Trauma. 2006;61(3):547–53. doi:10.1097/01.ta.0000196571.12389.ee (discussion 53–54).PubMedCrossRef

41.

Croce MA, Fabian TC, Menke PG, Waddle-Smith L, Minard G, Kudsk KA, et al. Nonoperative management of blunt hepatic trauma is the treatment of choice for hemodynamically stable patients. Results of a prospective trial. Ann Surg. 1995;221(6):744–53 (discussion 53–55).PubMedCentralPubMedCrossRef

42.

Ciraulo DL, Luk S, Palter M, Cowell V, Welch J, Cortes V, et al. Selective hepatic arterial embolization of grade IV and V blunt hepatic injuries: an extension of resuscitation in the nonoperative management of traumatic hepatic injuries. J Trauma. 1998;45(2):353–8 (discussion 8–9).PubMedCrossRef

43.

Huang YC, Wu SC, Fu CY, Chen YF, Chen RJ, Hsieh CH, et al. Tomographic findings are not always predictive of failed nonoperative management in blunt hepatic injury. Am J Surg. 2012;203(4):448–53. doi:10.1016/j.amjsurg.2011.01.031.PubMedCrossRef

44.

Letoublon C, Morra I, Chen Y, Monnin V, Voirin D, Arvieux C. Hepatic arterial embolization in the management of blunt hepatic trauma: indications and complications. J Trauma. 2011;70(5):1032–6. doi:10.1097/TA.0b013e31820e7ca1 (discussion 6–7).PubMedCrossRef

45.

Misselbeck TS, Teicher EJ, Cipolle MD, Pasquale MD, Shah KT, Dangleben DA, et al. Hepatic angioembolization in trauma patients: indications and complications. J Trauma. 2009;67(4):769–73. doi:10.1097/TA.0b013e3181b5ce7f.PubMedCrossRef

46.

Mohr AM, Lavery RF, Barone A, Bahramipour P, Magnotti LJ, Osband AJ, et al. Angiographic embolization for liver injuries: low mortality, high morbidity. J Trauma. 2003;55(6):1077–81. doi:10.1097/01.TA.0000100219.02085.AB (discussion 81–82).PubMedCrossRef

47.

Abdelrahman H, Ajaj A, Atique S, El-Menyar A, Al-Thani H. Conservative management of major liver necrosis after angioembolization in a patient with blunt trauma. Case Rep Surg. 2013;2013:954050. doi:10.1155/2013/954050.PubMedCentralPubMed

48.

Dabbs DN, Stein DM, Philosophe B, Scalea TM. Treatment of major hepatic necrosis: lobectomy versus serial debridement. J Trauma. 2010;69(3):562–7. doi:10.1097/TA.0b013e3181ebf591.PubMedCrossRef

49.

Kanakis MA, Thomas T, Martinakis VG, Brountzos E, Varsamidakis N. Successful management of severe blunt hepatic trauma by angiographic embolization. Updates Surg. 2012;64(4):303–6. doi:10.1007/s13304-011-0122-3.PubMedCrossRef

50.

Wahl WL, Brandt MM, Hemmila MR, Arbabi S. Diagnosis and management of bile leaks after blunt liver injury. Surgery. 2005;138(4):742–7. doi:10.1016/j.surg.2005.07.021 (discussion 7–8).PubMedCrossRef

51.

Yuan KC, Wong YC, Fu CY, Chang CJ, Kang SC, Hsu YP. Screening and management of major bile leak after blunt liver trauma: a retrospective single center study. Scand J Trauma Resusc Emerg Med. 2014;22(1):26. doi:10.1186/1757-7241-22-26.PubMedCentralPubMedCrossRef

52.

Bala M, Gazalla SA, Faroja M, Bloom AI, Zamir G, Rivkind AI, et al. Complications of high grade liver injuries: management and outcomewith focus on bile leaks. Scand J Trauma Resusc Emerg Med. 2012;20:20. doi:10.1186/1757-7241-20-20.PubMedCentralPubMedCrossRef

53.

Singh V, Narasimhan KL, Verma GR, Singh G. Endoscopic management of traumatic hepatobiliary injuries. J Gastroenterol Hepatol. 2007;22(8):1205–9. doi:10.1111/j.1440-1746.2006.04780.x.PubMedCrossRef

54.

Carrillo EH, Reed DN Jr, Gordon L, Spain DA, Richardson JD. Delayed laparoscopy facilitates the management of biliary peritonitis in patients with complex liver injuries. Surg Endosc. 2001;15(3):319–22. doi:10.1007/s004640000300.PubMedCrossRef

55.

Letoublon C, Chen Y, Arvieux C, Voirin D, Morra I, Broux C, et al. Delayed celiotomy or laparoscopy as part of the nonoperative management of blunt hepatic trauma. World J Surg. 2008;32(6):1189–93. doi:10.1007/s00268-007-9439-y.PubMedCrossRef

56.

Pilgrim CH, Usatoff V. Role of laparoscopy in blunt liver trauma. ANZ J Surg. 2006;76(5):403–6. doi:10.1111/j.1445-2197.2006.03731.x.PubMedCrossRef

57.

Pearl LB, Trunkey DD. Compartment syndrome of the liver. J Trauma. 1999;47(4):796–8.PubMedCrossRef

58.

Devakumar Murugesan S, Sathyanesan J, Lakshmanan A, Ramaswami S, Perumal S, Ulagendra Perumal S, et al. Massive hemobilia: a diagnostic and therapeutic challenge. World J Surg. 2014;. doi:10.1007/s00268-013-2435-5.

59.

Green MH, Duell RM, Johnson CD, Jamieson NV. Haemobilia. Br J Surg. 2001;88(6):773–86. doi:10.1046/j.1365-2168.2001.01756.x.PubMedCrossRef

60.

Srivastava DN, Sharma S, Pal S, Thulkar S, Seith A, Bandhu S, et al. Transcatheter arterial embolization in the management of hemobilia. Abdom Imaging. 2006;31(4):439–48. doi:10.1007/s00261-005-0392-7.PubMedCrossRef

61.

Buckman RF Jr, Miraliakbari R, Badellino MM. Juxtahepatic venous injuries: a critical review of reported management strategies. J Trauma. 2000;48(5):978–84.PubMedCrossRef

62.

Li Petri S, Gruttadauria S, Pagano D, Echeverri GJ, Di Francesco F, Cintorino D, et al. Surgical management of complex liver trauma: a single liver transplant center experience. Am Surg. 2012;78(1):20–5.PubMed

63.

Baumgartner F, Scudamore C, Nair C, Karusseit O, Hemming A. Venovenous bypass for major hepatic and caval trauma. J Trauma. 1995;39(4):671–3.PubMedCrossRef

64.

Gillmore D, McSwain NE Jr, Browder IW. Hepatic trauma: to drain or not to drain? J Trauma. 1987;27(8):898–902.PubMedCrossRef

65.

Mohseni S, Talving P, Kobayashi L, Kim D, Inaba K, Lam L, et al. Closed-suction drain placement at laparotomy in isolated solid organ injury is not associated with decreased risk of deep surgical site infection. Am Surg. 2012;78(10):1187–91.PubMed

66.

Mullins RJ, Stone HH, Dunlop WE, Strom PR. Hepatic trauma: evaluation of routine drainage. South Med J. 1985;78(3):259–61.PubMedCrossRef

67.

Noyes LD, Doyle DJ, McSwain NE Jr. Septic complications associated with the use of peritoneal drains in liver trauma. J Trauma. 1988;28(3):337–46.PubMedCrossRef

68.

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(3):621–7. doi:10.1097/TA.0b013e31819919f2 (discussion 7–9).PubMedCrossRef

69.

Anand RJ, Ferrada PA, Darwin PE, Bochicchio GV, Scalea TM. Endoscopic retrograde cholangiopancreatography is an effective treatment for bile leak after severe liver trauma. J Trauma. 2011;71(2):480–5. doi:10.1097/TA.0b013e3181efc270.PubMedCrossRef

Titel: Management of blunt liver injury: what is new?
verfasst von: J. Ward
L. Alarcon
A. B. Peitzman
Publikationsdatum: 01.06.2015
Verlag: Springer Berlin Heidelberg
Erschienen in: European Journal of Trauma and Emergency Surgery / Ausgabe 3/2015
Print ISSN: 1863-9933
Elektronische ISSN: 1863-9941
DOI: https://doi.org/10.1007/s00068-015-0521-0

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