Study Of Clinical Outcomes In Patients With Severe Hepatic Injury: Experience At A Tertiary Care Centre
Clinical outcome of severe hepatic injuries
Keywords:
Severe hepatic injury, Non operative management, Blunt trauma abdomen,Grade III and IV Liver injuryAbstract
Background: Management of liver trauma earlier used to be primarily surgical. With advancement in
diagnostic modalities it has gradually shifted to non operative management. Methods: The present study was
conducted on 40 patients with severe hepatic injuries (grade 3 onwards). All the patients were compared in terms of
various methods adopted for their management and their clinical outcomes Results: Out of a total of 40 patients,
maximum numbers of patients were in age group 18-24 years. 82.50 % patients had grade IV and rest had Grade V.
12 patients presented with shock on admission. Failure of NOM (non operative management) was seen in 25% of
cases . The average requirement of blood transfusion in our study was 2.157 1.74 units. Average hospital stay in
successful NOM cases was lower than in failed NOM. A total of 6 patients had to be operated upon in our study.
Active bleed was seen on laparotomy in four patients with no evidence of any injury causing peritonitis. Conclusion:
The success rates of non-operative management were significantly higher than the failures rates of non-operative
management, without any significant incidence of complications and delayed laparotomies. Grade of liver injury or
the amount of hemoperitoneum as detected on CT scan did not influence the outcome of non-operative
management. Non-operative management is thus the gold standard in hemo-dynamically stable patients. [Singh R
NJIRM 2016; 7(3): 45 - 51]
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Blunt hepatic trauma in adults. CT based
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injuries from blunt trauma abdomen. Indian J Surg.
2003;65(3):263-8.
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Kuncir E. Multidisciplinary approach for the
management of complex hepatic injuries AAST-OIS
grades IV-V: a prospective study. Scand J Surg.
2007;96(3):214-20
27. Sreeramulu PN, Venkatachalapathy TS, Anantharaj.
Blunt Trauma Liver-Conservative or Surgical
Management: A Retrospective Study. J Trauma
Treatment. 2012;1(8):1-4.
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Karani J. Outcomes and indications for
intervention in non-operative management ofpaediatric liver trauma: A 5 year retrospective
study. ClinRadiol. 2014;69(2):157-62.
29. Min Li, Wen-KuiYu,Xin-Bo Wang,WuJi,Jie-
ShouLi,Ning Li Non-operative management of
isolated liver trauma. Hepatobiliary& Pancreatic
Dis. Int. 2014;13(5): 545-50.
30. Morales Uribe CH, López CA, Cote JC, Franco ST,
Saldarriaga MF, Mosquera J, Villegas Lanau MI.
Surgical treatment of blunt liver trauma,
indications for surgery and results.Cir Esp.
2014;92(1):23-9.
31. Prichayudh S, Sirinawin C, Sriussadaporn S, Pak-art
R, Kritayakirana K, Samorn P, et al. Management of
liver injuries: predictors for the need of operation
and damage control surgery. Injury.
2014;45(9):1373-7.
32. Lin BC, Fang JF, Chen RJ, Wong YC, Hsu YP. Surgical
management and outcome of blunt major liver
injuries: experience of damage control laparotomy
with perihepatic packing in one trauma centre.
Injury. 2014;45(1):122-7.
33. Fabric M, Patrice L, Jean PC. Severe blunt trauma
of the liver: Study of mortality factors. J Trauma.
1993;35(6):865-69.
34. Kimura A, Otsuka T. Emergency center
ultrasonography in the evaluation of
hemoperitoneum: a prospective study. J Trauma
1991;31:20-3.
35. Pachter HL, Hofstetter SR. The current status of
non-operative management of adult blunt hepatic
injuries.Am J Surg. 1995; 169:442-54.
36. Sherman HF, Savage BA,Jones LM, Barretterr,
Latenser BA, Varcelotti JR, et al. Non operative
management of blunt hepatic injuries. Safe at any
grade?J Trauma. 194;37(4):616-21.
37. Goan YG, Huang MS, Lin JM.Non-operative
management for extensive hepatic and splenic
injuries with significant hemoperitoneum in
adults.J Trauma. 1998;36:360-5.
38. Velmahos GC, Toutouzas KG, Radin R, Chan L,
Demetriades D. Non operative treatment of blunt
injury to solid abdominal organs. Arch Surg.
2003;138:844-51.
the Hepatic Artery for Trauma of the Liver. Surg.
Gynecol Obstet. 1975;141:187.
2. Balasegaram M. Blunt Injuries to the Liver:
Problems and Management. Ann Surg.
1969;169:544.
3. Baxter CR, Crenshaw CA, Lehman I, Zedlitz WH,
Shires GT, Naschke MD. A Practical Method of
Renal Hypothermia.J Trauma. 1963;3:349.
4. Bengmark S. Liver Surgery. In Allgower, M. (ed.):
Progress in Surgery. New York, S. Karger, 1968; vol.
6.
5. Bengmark S and Rosengren K. Angiographic Study
of the Collateral Circulation to the Liver after
Ligation of the Hepatic Artery in Man. Am J Surg.
1970;119:620.
6. Drezner AD, Foster JH. Decreasing Morbidity after
Liver Trauma. Am J Surg. 1975;129:483.
7. Fortner JG, Beattie E J, Watson RC, et al. Surgery in
Liver Tumors. Curr.Probl Surg. 1972.
8. Lewis FR, Lim RC, Blaisdell F.W. Hepatic Artery
Ligation: Adjunct in the Management of Massive
Hemorrhage from the Liver. J Trauma.1974;
14:743.
9. Sandblom P. Hemobilia. SurgClin North Am.
1973;53:1191.
10. Walt AJ. The surgical management of hepatic
trauma and its complications. Ann R CollSurg Engl.
1969; 45(6): 319-39.
11. Foley WD, Cates JD, Kellman GM, Langdon T,
Aprahamian C, Lawson TL, et al. Treatment of
blunt hepatic injuries: role of CT. Radiology.
1987;164:635-8.
12. Farnell MB, Spencer MP, Thompson E, Williams HJ
Jr, Mucha P Jr, Ilstrup DM. Non-operative
management of blunt hepatic trauma in
adults.Surgery. 1988;104:748-56.
13. Delius RE, Frankel W, Coran AG. A comparison
between operative and non- operative
management of blunt injuries to liver and spleen in
adult and pediatric patients.Surgery.
1989;10(5):788-93.
14. Mirvis SE, Whitley NO, Vainwright JR, Gens DR.
Blunt hepatic trauma in adults. CT based
classification and correlation with prognosis and
treatment. Radiology. 1989;171:27-32.
15. Federico JA, Horner WR, Clark DE, Isler RJ. Blunt
hepatic trauma: non operative management I
adults. Arch Surg. 1990;125:905-9.
16. Hollands MJ, Little JM. Non operative management
of blunt liver injuries.Br J Surg. 1991;78:968-72.
17. Hammond JC, Canal DF, BroadieTA.Non operative
management of adult blunt hepatic trauma in a
municipal trauma centre. Am J Surg. 1992;58:551-
6.
18. Durham RM, Buckley J, Keegan M, Fravell S,
Shapiro MJ, Mazuski J.. Management of blunt
hepatic injuries. Am J Surg. 1992;164:477-81.
19. Pachter HL, Spencer FC, Hofstetter SR, Liang HG,
Coppa GF. Significant trends in the treatment of
hepatic trauma experience with 411 injuries. Am J
Surg. 1992;215:492-505.
20. Moore EE, Cogbill TH, Jurkovich GJ, Shackford SR,
Malangoni MA, Champion HR. Organ injury scaling:
spleen and liver (1994 revision). J Trauma.
1995;38(1):323-4.
21. Meredith JW, Young JS, Bowling J, Roboussin D.
Nonoperative management of blunt hepatic
trauma: The exception or the rule? J Trauma.
1994;36:529-35.
22. Sherman HF, Savage BA, Jones LM, Barretterr,
Latenser BA, Varcelotti JR, McAvley CE, Jones RT,
Myers AH. Non operative management of blunt
hepatic injuries.Safe at anygrade?J Trauma.
1994;37(4):616-21.
23. Malhotra AK, Latiji R, Fabian TC, Croce MA, Gavian
TJ, Kuadsk KA, Minard G, et al. Blunt hepatic injury:
A paradigm shift from operative to non operative
management in the1990s. Ann of Surg.
2000;231(6):804-13.
24. Brammer RD, Bramhall SR, Mirza DF, Mayer AD,
Mcmaster P, Buckles JAC. A 10 year experience of
complex liver trauma. Br J Surg. 2002;89: 1532-7.
25. Mohapatra S, Pattanayak SP, Rao KRRM, Bastia B.
Options in the management of solid visceral
injuries from blunt trauma abdomen. Indian J Surg.
2003;65(3):263-8.
26. Asensio JA, Petrone P, GarcÃa-Núñez L, Kimbrell B,
Kuncir E. Multidisciplinary approach for the
management of complex hepatic injuries AAST-OIS
grades IV-V: a prospective study. Scand J Surg.
2007;96(3):214-20
27. Sreeramulu PN, Venkatachalapathy TS, Anantharaj.
Blunt Trauma Liver-Conservative or Surgical
Management: A Retrospective Study. J Trauma
Treatment. 2012;1(8):1-4.
28. Inchingolo R, Ljutikov A, Deganello A, Kane P,
Karani J. Outcomes and indications for
intervention in non-operative management ofpaediatric liver trauma: A 5 year retrospective
study. ClinRadiol. 2014;69(2):157-62.
29. Min Li, Wen-KuiYu,Xin-Bo Wang,WuJi,Jie-
ShouLi,Ning Li Non-operative management of
isolated liver trauma. Hepatobiliary& Pancreatic
Dis. Int. 2014;13(5): 545-50.
30. Morales Uribe CH, López CA, Cote JC, Franco ST,
Saldarriaga MF, Mosquera J, Villegas Lanau MI.
Surgical treatment of blunt liver trauma,
indications for surgery and results.Cir Esp.
2014;92(1):23-9.
31. Prichayudh S, Sirinawin C, Sriussadaporn S, Pak-art
R, Kritayakirana K, Samorn P, et al. Management of
liver injuries: predictors for the need of operation
and damage control surgery. Injury.
2014;45(9):1373-7.
32. Lin BC, Fang JF, Chen RJ, Wong YC, Hsu YP. Surgical
management and outcome of blunt major liver
injuries: experience of damage control laparotomy
with perihepatic packing in one trauma centre.
Injury. 2014;45(1):122-7.
33. Fabric M, Patrice L, Jean PC. Severe blunt trauma
of the liver: Study of mortality factors. J Trauma.
1993;35(6):865-69.
34. Kimura A, Otsuka T. Emergency center
ultrasonography in the evaluation of
hemoperitoneum: a prospective study. J Trauma
1991;31:20-3.
35. Pachter HL, Hofstetter SR. The current status of
non-operative management of adult blunt hepatic
injuries.Am J Surg. 1995; 169:442-54.
36. Sherman HF, Savage BA,Jones LM, Barretterr,
Latenser BA, Varcelotti JR, et al. Non operative
management of blunt hepatic injuries. Safe at any
grade?J Trauma. 194;37(4):616-21.
37. Goan YG, Huang MS, Lin JM.Non-operative
management for extensive hepatic and splenic
injuries with significant hemoperitoneum in
adults.J Trauma. 1998;36:360-5.
38. Velmahos GC, Toutouzas KG, Radin R, Chan L,
Demetriades D. Non operative treatment of blunt
injury to solid abdominal organs. Arch Surg.
2003;138:844-51.
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Published
2018-01-21
How to Cite
Singh, R. P., Trehan, M., Singla, S. K., Chahal, H., Mahajan, A., Garg, N., J, agdeep C., & Selhi, J. S. (2018). Study Of Clinical Outcomes In Patients With Severe Hepatic Injury: Experience At A Tertiary Care Centre: Clinical outcome of severe hepatic injuries. National Journal of Integrated Research in Medicine, 7(3), 45–51. Retrieved from http://www.nicpd.ac.in/ojs-/index.php/njirm/article/view/1076
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