DOI: http://dx.doi.org/10.18203/2349-2902.isj20190470

Study of blunt trauma abdomen involving liver injuries based on grade of injury, management: a single centre study

Vinod Kumar Jyothiprakasan, Chinthakindhi Madhusudhan, Challa Sravya Reddy

Abstract


Background: Modern treatment of liver trauma is increasingly non-operative. Advantages of non-operative management include avoidance of non-therapeutic celiotomies and the associated cost and morbidity, fewer intra-abdominal complications compared to operative repair and reduced transfusion risks. It is associated with a low overall morbidity and mortality and does not result in increase in length of the hospital stay. The objectives was to study efficacy of non-operative management of blunt liver injury.

Methods: Seventy patients were studied, out of which 59 were initially given a trial of non-operative management and 11 patients were immediately shifted to the operating room. Of the 59 patients initially considered for non-operative management, 5 of them became unstable hemodynamically and were operated. Any complications arising in patients in non-operative group were managed with the help of interventional radiological procedures.

Results: Total 54 patients were managed successfully without operative intervention which included patients with higher grade of injuries. 11 patients were shifted to surgery on arrival as they did not respond to resuscitation measures. Mortality and morbidity were found to be higher in patients undergoing surgery. Also, number of transfusions required, ICU stay and total number of days in hospital were higher in operated group. High ISS, low BP at admission, higher grade of injury in this study were seen in patients who failed non-operative management.

Conclusions: Non-operative management is the initial management of choice in hemodynamically stable patients, irrespective of the grade of injury and is associated with less mortality and morbidity.


Keywords


Blunt liver injury, Efficacy, Grade of injury, Hemodynamic status

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References


Gururaj G. Injuries in India: A national perspective. Background Papers: Burden of Disease in India Equitable Development-Healthy Future. New Delhi: National Commission on Macroeconomics and Health, Ministry of Health & Family Welfare, Government of India. 2005 Sep:325-47. Available at: https://www.who.int/macrohealth/action/NCMH_Burden%20of%20disease_(29%20Sep%202005).pdf Accessed 31 March 2016.

Committee on Trauma, American College of Surgeons: National Trauma Data Bank annual report 2009, Chicago, 2009, American College of Surgeons.

Pringle JH. Notes on the arrest of hepatic haemorrhage due to trauma. Ann Surg. 1908;48:541-8.

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 Jun;231(6):804.

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 Acute Care Surg. 1996;40(1):31-8

Lyuboslavsky Y, Pattillo MM. Stable patients with blunt liver injury: observe, do not operate. Crit Care Nursing Quarterly. 2009;32(1):14-8.

6. Teasdale G, Jennett B. Assessment of coma and impaired consciousness: a practical scale. Lancet. 1974;304(7872):81-4.

Champion HR, Sacco WJ, Copes WS, Gann DS, Gennarelli TA, Flanagan ME. A revision of the trauma score. J Trauma. 1989;29(5):623-9.

8. Moore EE, Shackford SR, Pachter HL, McAninch JW, Browner BD, Champion HR, et al. Organ injury scaling: spleen, liver, and kidney. J Trauma. 1989;29(12):1664-6.

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):475-81.

Hommes M, Navsaria PH, Schipper IB, Krige JE, Kahn D, Nicol AJ. Management of blunt liver trauma in 134 severely injured patients. Injury. 2015 May 31;46(5):837-42.

Norrman G, Tingstedt B, Ekelund M, Andersson R. Nonā€operative management of blunt liver trauma: feasible and safe also in centres with a low trauma incidence. HPB. 2009 Feb 1;11(1):50-6.

Wilden GM, Velmahos GC, D'andrea KJ, Jacobs L, DeBusk MG, Adams CA, et al. Successful non-operative management of the most severe blunt renal injuries: a multicenter study of the research consortium of New England Centers for trauma. JAMA Surg. 2013 Oct 1;148(10):924-31.

Zago TM, Pereira BM, Calderan TR, Hirano ES, Rizoli S, Fraga GP. Blunt hepatic trauma: comparison between surgical and nonoperative treatment. Rev Col Bras Cirur. 2012;39(4):307-13.