Massive Liver Trauma—Multidisciplinary Approach and Minimal Invasive Surgery can Salvage Patients

详细信息    查看全文

• 作者：Pinky M. Thapar (1) (2)
  Ravindra M. Ghawat (1)
  Abhay N. Dalvi (1)
  Muktachand L. Rokade (1)
  Roji M. Philip (1)
  Gireesh M. Warawdekar (1)
  Mukta R. Bapat (1)
  
• 关键词：Hepatic trauma ; Angiographic embolization ; Laparoscopic lavage ; Biliary fistula
• 刊名：Indian Journal of Surgery
• 出版年：2013
• 出版时间：June 2013
• 年：2013
• 卷：75
• 期：1-supp
• 页码：449-452
• 全文大小：307KB
• 参考文献：1. Croce MA, Fabian TC, Menke PG, Waddle-Smith L, Minard G, Kudsk KA et al (1995) Nonoperative management of blunt hepatic trauma is the treatment of choice for hemodynamically stable patients. Results of a prospective trial. Ann Surg 221:744-55 CrossRef
  2. Cothren CC, Moore EE (2008) Hepatic trauma. Eur J Trauma Emg Surg 34:339-54 CrossRef
  3. Cresswell AB, Bowles MJ, Wendon JA (2007) The management of liver trauma. In: Vincent JL (ed) Yearbook of intensive care and emergency medicine, 1st edn. Springer, Berlin, pp 666-7.
  4. Trunkey DD (2004) Hepatic trauma: contemporary management. Surg Clin N Am 84:437-50 CrossRef
  5. Letoublon C, Chen Y, Arvieux C, Voirin D, Morra I, Broux C et al (2008) Delayed celiotomy or laparoscopy as part of the nonoperative management of blunt hepatic trauma. World J Surg 32:1189-193 CrossRef
  6. Monnin V, Sengel C, Thony F, Bricault I, Voirin D, Letoublon C et al (2008) Place of arterial embolization in severe blunt hepatic trauma: a multidisciplinary approach. Cardiovasc Intervent Radiol 31:875-82 CrossRef
  7. Moore FA, McKinley BA, Moore EE, Nathens AB, West M, Shapiro MB et al (2006) Inflammation and the host response to injury, a large-scale collaborative project: patient-oriented research core-standard operating procedures for clinical care. III. Guidelines for shock resuscitation. J Trauma 61:82-9 CrossRef
  8. Carrillo EH, Reed DN Jr, Gordon L, Spain DA, Richardson JD (2001) Delayed laparoscopy facilitates the management of biliary peritonitis in patients with complex liver injuries. Surg Endosc 15:319-22 CrossRef
  9. Delgado Millian MA, Deballon PO (2001) Computed tomography, angiography and endoscopic retrograde cholangiopancreatography in the nonoperative management of hepatic and splenic trauma. World J Surg 25:1397-402
  10. Catalano O, Lobianco R, Raso MM, Siani A (2005) Blunt hepatic trauma: evaluation with contrast-enhanced sonography: sonographic findings and clinical application. J Ultrasound Med 24:299-10
  
• 作者单位：Pinky M. Thapar (1) (2)
  Ravindra M. Ghawat (1)
  Abhay N. Dalvi (1)
  Muktachand L. Rokade (1)
  Roji M. Philip (1)
  Gireesh M. Warawdekar (1)
  Mukta R. Bapat (1)
  
  1. Department of Minimal Invasive surgery, Critical Care, Radiology and Endoscopy, Jupiter Hospital, Thane Maharashtra, India
  2. D-6, Vishram Dham, Veena Nagar Phase II, Mulund (West), Mumbai, 80, India
  

文摘

Management of massive liver trauma (grades IV–VI) is associated with high morbidity and mortality. It can pose serious challenges to treating physician and requires multimodality interventions. For a successful outcome, timing of intervention is crucial. We report a case of grade V hepatic injury treated successfully with angioembolization, laparoscopic lavage, and endoscopic stenting during a time period from admission to discharge on the 24th day. Angioembolization was performed at admission after resuscitation as CT scan showed active extravasation in the arterial phase. Laparoscopic lavage and drainage was performed on the fifth day as abdominal inflammatory response failed to respond to medical management. There was biliary component of abdominal fluid noticed during laparoscopy, which manifested by postoperative localized biliary fistula; hence endoscopic stenting of the bile duct was performed on the seventh day. The patient recovered well with timely minimal invasive approach and was fine at 1?year follow-up.