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Liver Injury

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Selective nonoperative management of penetrating abdominal solid organ injuries.
Demetriades D, Hadjizacharia P, Constantinou C, Brown C, Inaba K, Rhee P, Salim A.
Ann Surg. 2006 Oct;244(4):620-8.

Rationale for inclusion: LA County presented a series of 152 patients sustaining penetrating abdominal solid organ injury in which nonoperative management was successful when used selectively, challenging the standard practice that all penetrating organ injury mandates exploration.

Citations - 258 (as of July 2017)

Complications of nonoperative management of high-grade blunt hepatic injuries.
Kozar RA, Moore JB, Niles SE, Holcomb JB, Moore EE, Cothren CC, Hartwell E, Moore FA.
J Trauma. 2005 Nov;59(5):1066-71.

Rationale for inclusion: A total of 337 patients with high grade (III-V) blunt hepatic injuries were analyzed with respect to complications and subsequent management.  Their results supported the nonoperative management of all grades of liver injury, accepting and recommending the anticipation of a significant number of complications including bleeding, liver abscesses, and biliary complications.

Citations - 180 (as of July 2017)

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

Rationale for inclusion: This study was a single-center analysis of nonoperative blunt hepatic trauma as compared to the previous standard of operative management, finding equivalent mortality with a reduction in complication rate following nonoperative management.  

Citations - 349 (as of July 2017)

Interventional techniques are useful adjuncts in nonoperative management of hepatic injuries.
Carrillo EH, Spain DA, Wohltmann CD, Schmieg RE, Boaz PW, Miller FB, Richardson JD.
J Trauma. 1999 Apr;46(4):619-22; discussion 622-4.

Rationale for inclusion: After nonoperative management of hepatic trauma was introduced and became standard of care for hemodynamically stable patients, this retrospective review described the significant complication rate (24%) seen with nonoperative management.  The majority of these complications were managed by less invasive procedures than laparotomy including ERCP and embolization.  

Citations - 231 (as of July 2017)

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

Rationale for inclusion: A multi-center retrospective analysis of 13 level I trauma centers, this study concluded that nonoperative management of all hemodynamically stable liver injuries should be attempted irrespective of grade of injury or degree of hemoperitoneum, recommending serial imaging within 7-10 days after injury.

Citations - 475 (as of July 2017)

Nonoperative management of blunt hepatic trauma is the treatment of choice for hemodynamically stable patients. Results of a prospective trial.
Croce MA, Fabian TC, Menke PG, Waddle-Smith L, Minard G, Kudsk KA, Patton JH Jr, Schurr MJ, Pritchard FE.
Ann Surg. 1995 Jun;221(6):744-53; discussion 753-5.

Rationale for inclusion: Following many retrospective reviews of nonoperative management for blunt hepatic trauma, this serves as the first prospective analysis, citing successful nonoperative management with fewer transfusions and fewer abdominal complications than their surgical controls.  

Citations - 505 (as of July 2017)

Significant trends in the treatment of hepatic trauma. Experience with 411 injuries.
Pachter HL, Spencer FC, Hofstetter SR, Liang HG, Coppa GF.
Ann Surg. 1992 May;215(5):492-500; discussion 500-2.

Rationale for inclusion: This series reviewed 411 consecutive patients with traumatic liver injuries and promoted the successful nonoperative management of the majority of these injuries.  Complex injury patterns were managed with a combination of surgical techniques with increased survival compared to patients in whom shunting was performed.  

Citations - 350 (as of July 2017)

Fatal hepatic hemorrhage: an unresolved problem in the management of complex liver injuries.
Beal SL.
J Trauma. 1990 Feb;30(2):163-9.

Rationale for inclusion: This paper analyzed surgical techniques utilized for hemostasis following severe liver injury providing a critical algorithm for successful surgical control.

Citations - 305 (as of July 2017)

Severe hepatic trauma: a multi-center experience with 1,335 liver injuries.
Cogbill TH, Moore EE, Jurkovich GJ, Feliciano DV, Morris JA, Mucha P.
J Trauma. 1988 Oct;28(10):1433-8.

Rationale for inclusion: This serves as a descriptive review of the management of 210 complex liver lacerations (Grade III, IV, and V) in the 1980s, including the placement of caval shunt. This paper analyzed surgical techniques utilized for hemostasis following severe liver injury providing a critical algorithm for successful surgical control in 38 patients with a survival of only 4 of these patients.  

Citations - 400 (as of July 2017)

The role of packing and planned reoperation in severe hepatic trauma.
Carmona RH, Peck DZ, Lim RC Jr.
J Trauma. 1984 Sep;24(9):779-84.

Rationale for inclusion: This series describes the utility of peri-hepatic packing with planned reoperation as a useful technique for the control of liver hemorrhage prior to definitive control, citing no additional morbidity or mortality as compared to definitive control on initial exploration.

Citations - 164 (as of July 2017)

Notes on the Arrest of Hepatic Hemorrhage Due to Trauma.
Pringle JH.
Ann Surg. 1908 Oct;48(4):541-9.

Rationale for inclusion: Written by Pringle and published in 1908, this represents one of the earliest descriptions regarding the treatment of severe liver injury and control of hemorrhage and is significant for its historical value.

Citations - 1307 (as of July 2017)

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