nach oben

European Journal of Trauma and Emergency Surgery

Erschienen in:

24.01.2018 | Original Article

Selective nonoperative management of liver gunshot injuries

verfasst von: Pradeep Navsaria, Andrew Nicol, Jake Krige, Sorin Edu, Sharfuddin Chowdhury

Erschienen in: European Journal of Trauma and Emergency Surgery | Ausgabe 2/2019

Einloggen, um Zugang zu erhalten

Abstract

Purpose

Nonoperative management (NOM) of gunshot liver injuries (GLI) is infrequently practiced. The aim of this study was to assess the safety of selective NOM of GLI.

Methods

A prospective, protocol-driven study, which included patients with GLI admitted to a level 1 trauma center, was conducted over a 52-month period. Stable patients without peritonism or sustained hypotension with right-sided thoracoabdominal (RTA) and right upper quadrant (RUQ), penetrating wounds with or without localized RUQ tenderness, underwent contrasted abdominal CT scan to determine the trajectory and organ injury. Patients with established liver and/or kidney injuries, without the evidence of hollow viscus injury, were observed with serial clinical examinations. Outcome parameters included the need for delayed laparotomy, complications, the length of hospital stay and survival.

Results

During the study period, 54 (28.3%) patients of a cohort of 191 patients with GLI were selected for NOM of hemodynamic stability, the absence of peritonism and CT imaging. The average Revised Trauma Score (RTS) and Injury Severity Score (ISS) were 7.841 and 25 (range 4–50), respectively. 21 (39%) patients had simple (Grades I and II) and 33 (61%) patients sustained complex (Grades III to V) liver injuries. Accompanying injuries included 12 (22.2%) kidney, 43 (79.6%) diaphragm, 20 (37.0%) pulmonary contusion, 38 (70.4%) hemothoraces, and 24 (44.4%) rib fractures. Three patients required delayed laparotomy resulting in an overall success of NOM of 94.4%. Complications included: liver abscess (1), biliary fistula (5), intrahepatic A-V fistula (1) and hospital-acquired pneumonia (3). The overall median hospital stay was 6 (IQR 4–11) days, with no deaths.

Conclusion

The NOM of carefully selected patients with GLI is safe and associated with minimal morbidity.

Navsaria PH, Berli J, Edu S, Nicol AJ. Non-operative management of abdominal stab wounds: an analysis of 186 patients. S Afr J Surg. 2007;45:128–32.PubMed

Moore EE. When is nonoperative management of a gunshot wound to the liver appropriate? J Am Coll Surg. 1999;188:427–8.CrossRefPubMed

Garrett KA, Stain SC, Rosati C. Nonoperative management of liver gunshot injuries. Curr Surg. 2006;63:169–73.CrossRefPubMed

Navsaria PH, Nicol AJ, Krige JE, Edu S. Selective nonoperative management of liver gunshot Injuries. Ann Surg. 2009;249:653–6.CrossRefPubMed

Demetriades D, Rabinowitz B, Sofianos C. Non operative management of penetrating liver injuries: a prospective study. Br J Surg. 1986;73:736–7.CrossRefPubMed

Scalea TM. Penetrating Liver Injuries. Curr Trauma Rep. 2015;1(2):69–75.CrossRef

Renz BM, Feliciano DV. Gunshot wounds to the right thoracoabdomen: a prospective study of nonoperative management. J Trauma. 1994;37:737–44.CrossRefPubMed

Chmielewski GW, Nicholas JM, Dulchavsky SA, Diebel LN. Nonoperative management of gunshot wounds of the abdomen. Am Surg. 1995;61:665–8.PubMed

Ginzburg E, Carrillo EH, Kopelman T, McKenney MG, Kirton OC, Shatz DV, et al. The role of computed tomography in selective management of gunshot wounds to the abdomen and flank. J Trauma. 1998;45:1005–9.CrossRefPubMed

10.

Demetriades D, Gomez H, Chahwan S, Charalambides K, Velmahos G, Murray J, et al. Gunshot injuries to the liver: the role of selective nonoperative management. J Am Coll Surg. 1999;188:343–8.CrossRefPubMed

11.

Omoshoro-Jones JA, Nicol AJ, Navsaria PH, Zellweger R, Krige JE, Kahn D. Selective non-operative management of liver gunshot injuries. Br J Surg. 2005;92:890–5.CrossRefPubMed

12.

Pal KM, Khan A. Nonoperative management of penetrating liver trauma. Injury. 2000;31:199–201.CrossRefPubMed

13.

Shanmuganathan K, Mirvis SE, Chiu WC, Killeen KL, Scalea TM. Triple-contrast helical CT in penetrating torso trauma: a prospective study to determine peritoneal violation and the need for laparotomy. Am J Roentgenol. 2001;177:1247–56.CrossRef

14.

DuBose J, Inaba K, Teixeira PG, Pepe A, Dunham MB, McKenney M. Selective nonoperative management of solid organ injury following abdominal gunshot wounds. Injury. 2007;38:1084–90.CrossRefPubMed

15.

Marr JDF, Krige JEJ, Terblanche J. Analysis of 153 gunshot wounds of the liver. Br J Surg. 2000;87:1030–4.CrossRefPubMed

16.

Demetriades D, Hadjizacharia P, Constantinou C, Brown C, Inaba K, Rhee P, et al. Selective nonoperative management of penetrating abdominal solid organ injuries. Ann Surg. 2006;244:620–8.PubMedPubMedCentral

17.

Renz BM, Bott J, Feliciano DV. Failure of nonoperative treatment of a gunshot wound to the liver predicted by computed tomography. J Trauma. 1996;40:191–93.CrossRefPubMed

18.

Dabbs DN, Stein DM, Scalea TM. Major hepatic necrosis: a common complication after angioembolization for treatment of high-grade liver injuries. J Trauma Acute Care Surg. 2009;66(3):621–9.CrossRef

19.

Michailidou M, Velmahos GC, Wilden G, Alam HB, de Moya M, Chang Y. Blush on trauma computed tomography: not as bad as we think. J Trauma Acute Care Surg. 2012;73(3):580–6.CrossRefPubMed

20.

Dabbs DN, Stein DM, Philosophe B, Scalea TM. Treatment of major hepatic venous: lobectomy versus serial debridements. J Trauma. 2010;69:562–67.CrossRefPubMed

21.

Philips T, Scalafini SJ, Goldstein A, Scalea T, Panetta T, Shaftan G. Use of contrast–enhanced CT enema in the management of penetrating trauma of the flank and back. J Trauma 986; 6:593–601.

22.

Sherck J, Shatney C, Sensaki K, Selivanov V. The accuracy of computed tomography in the diagnosis of blunt small bowel perforation. Am J Surg. 1994;168:670–5.CrossRefPubMed

23.

Bala M, Gazalla SA, Faroja M, Bloom AI, Zamir G, Rivkind AI, et al. Complications of high grade liver injuries: management and outcome with focus on bile leaks. Scand J Trauma Resusc Emerg Med. 2012;20:20. https://doi.org/10.1186/1757-7241-20-20 (PMCID: PMC3352307).CrossRefPubMedPubMedCentral

24.

Navsaria PH, Nicol AJ. Selective nonoperative management of kidney gunshot injuries. World J Surg. 2009;33:553–7.CrossRefPubMed

25.

Velmahos GC, Demetriades D, Cornwell EE III, et al. Selective management of renal gunshot wounds. Br J Surg. 1998;85:1121–4.CrossRefPubMed

26.

Wessells H, McAninch JW, Meyer A, Bruce J. Criteria for nonoperative management of significant penetrating renal lacerations. J Urol. 1997;157:2427.

27.

Moolman C, Navsaria PH, Lazarus J, Pontin A, Nicol AJ. Nonoperative management of penetrating kidney injuries: a prospective audit. J Urol. 2012;188:169 – 73.CrossRefPubMed

28.

Leukhardt WH, Golob JF, McCoy AM, Fadlalla AM, et al. Follow-up disparities after trauma: a real problem for outcomes research. Am J Surg. 2010;199:348–53.CrossRefPubMed

Titel: Selective nonoperative management of liver gunshot injuries
verfasst von: Pradeep Navsaria
Andrew Nicol
Jake Krige
Sorin Edu
Sharfuddin Chowdhury
Publikationsdatum: 24.01.2018
Verlag: Springer Berlin Heidelberg
Erschienen in: European Journal of Trauma and Emergency Surgery / Ausgabe 2/2019
Print ISSN: 1863-9933
Elektronische ISSN: 1863-9941
DOI: https://doi.org/10.1007/s00068-018-0913-z

Arthropedia

Grundlagenwissen der Arthroskopie und Gelenkchirurgie. Erweitert durch Fallbeispiele, Videos und Abbildungen.
» Jetzt entdecken

Neu im Fachgebiet Orthopädie und Unfallchirurgie

Ein Drittel der jungen Ärztinnen und Ärzte erwägt abzuwandern

07.05.2024 Medizinstudium Nachrichten

Extreme Arbeitsverdichtung und kaum Supervision: Dr. Andrea Martini, Sprecherin des Bündnisses Junge Ärztinnen und Ärzte (BJÄ) über den Frust des ärztlichen Nachwuchses und die Vorteile des Rucksack-Modells.

Aquatherapie bei Fibromyalgie wirksamer als Trockenübungen

03.05.2024 Fibromyalgiesyndrom Nachrichten

Bewegungs-, Dehnungs- und Entspannungsübungen im Wasser lindern die Beschwerden von Patientinnen mit Fibromyalgie besser als das Üben auf trockenem Land. Das geht aus einer spanisch-brasilianischen Vergleichsstudie hervor.

Endlich: Zi zeigt, mit welchen PVS Praxen zufrieden sind

IT für Ärzte Nachrichten

Darauf haben viele Praxen gewartet: Das Zi hat eine Liste von Praxisverwaltungssystemen veröffentlicht, die von Nutzern positiv bewertet werden. Eine gute Grundlage für wechselwillige Ärztinnen und Psychotherapeuten.

Proximale Humerusfraktur: Auch 100-Jährige operieren?

01.05.2024 DCK 2024 Kongressbericht

Mit dem demographischen Wandel versorgt auch die Chirurgie immer mehr betagte Menschen. Von Entwicklungen wie Fast-Track können auch ältere Menschen profitieren und bei proximaler Humerusfraktur können selbst manche 100-Jährige noch sicher operiert werden.

Update Orthopädie und Unfallchirurgie

Bestellen Sie unseren Fach-Newsletter und bleiben Sie gut informiert.

Newsletter bestellen

Springer Medizin

Abstract

Purpose

Methods

Results

Conclusion

Bitte loggen Sie sich ein, um Zugang zu diesem Inhalt zu erhalten

Weitere Artikel der Ausgabe 2/2019

Analysis of quality of life after major trauma: a spanish follow-up cohort study

Clinical characteristics and prognosis of traumatic head injury following road traffic accidents admitted in ICU “analysis of 694 cases”

Decision-making for complex scapula and ipsilateral clavicle fractures: a review

Treatment of combined traumatic brain injury and hemorrhagic shock with fractionated blood products versus fresh whole blood in a rat model

Minimally invasive surgical treatment using ‘iliac pillar’ screw for isolated iliac wing fractures in geriatric patients: a new challenge

Higher age is a major driver of in-hospital adverse events independent of comorbid diseases among patients with isolated mild traumatic brain injury