Blunt liver injury: from non-operative management to liver transplantation
2003; Elsevier BV; Volume: 34; Issue: 3 Linguagem: Inglês
10.1016/s0020-1383(02)00283-8
ISSN1879-0267
AutoresMassimiliano Veroux, Umberto Cillo, Alberto Brolese, Pierfrancesco Veroux, Carmelo Madia, Pietro Fiamingo, Giacomo Zanus, A Buffone, Enrico Gringeri, D.F. D'Amico,
Tópico(s)Urological Disorders and Treatments
ResumoTherapeutic options for blunt hepatic trauma include both non-operative and operative management. We have reviewed our experience of the management of blunt hepatic trauma, from non-operative to liver transplantation. A total of 72 patients with blunt hepatic injury observed at the first surgical unit of Padua in a 3-year period (1998-2000) were analysed; we also included a patient who had a liver transplant in 1993 for severe liver trauma. Twenty-nine patients (39.7%) were treated conservatively, with a 93% success rate; 60.3% were treated surgically. Suture hepatorraphy was the most common procedure performed (52.3%). Advantages of non-operative management in our experience were the reduced need for transfusion (1.1U versus 4.3U) with 92% of patients not needing transfusion, and a reduced stay in the intensive care unit; there was no liver-related mortality. The overall morbidity in surgical patients was 30%, with 16% liver-related complications. Twelve surgical patients (27.2%) died, with a liver-related mortality of 18.2%. A large number of patients may present with an associated endo-abdominal injury, even in low-grade liver trauma, requiring rapid laparotomy. In high-grade hepatic trauma, the evolution toward liver failure is an indication for liver transplantation.
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