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Selection criteria for non-surgical treatment of liver injury in adult polytraumatized patients.
- Source :
-
Chirurgia italiana [Chir Ital] 2002 Sep-Oct; Vol. 54 (5), pp. 621-8. - Publication Year :
- 2002
-
Abstract
- Conservative treatment of hepatic trauma is currently implemented in 80-90% of cases with a success rate of 92.5% and is mainly based on the haemodynamic status of the patients. We conducted a retrospective study of 71 patients with hepatic trauma from January 1993 to April 2001 and reviewed our experience with surgical and conservative treatment, also considering associated extrahepatic lesions. Fifty-three (74.6%) patients with liver trauma underwent celiotomy and 18 (25.3%) were treated conservatively. Haemodynamic instability was the most common indication for surgery (34 patients). Eighteen (52.9%) patients required an extrahepatic surgical procedure. Nineteen (35.8%) patients were haemodynamically stable and the indications for surgery in these cases were penetrating trauma in 6, large haemoperitoneum in 12, and diaphragmatic rupture in 1. The overall mortality in the operated group was 15%, but the liver-related mortality rate was 7.5%. The success rate for conservative management was 88.8%, with mortality 0% and morbidity 11%. The patients managed conservatively had grades of injury (I-III) similar to the haemodynamically stable operated patients (94.4% vs 94.7%), whereas the haemoperitoneum was larger in the operated group (63.1% vs 11.1%). Non-operative management is the preferred treatment option in haemodynamically stable patients with limited haemoperitoneum, regardless of the grade of the hepatic lesion, and without severe intra-abdominal injuries.
- Subjects :
- Adolescent
Adult
Aged
Aged, 80 and over
Diaphragm injuries
Female
Hemodynamics
Hemoperitoneum surgery
Humans
Male
Middle Aged
Multiple Trauma etiology
Patient Selection
Retrospective Studies
Rupture
Wounds, Nonpenetrating etiology
Wounds, Penetrating surgery
Liver injuries
Multiple Trauma therapy
Wounds, Nonpenetrating therapy
Subjects
Details
- Language :
- English
- ISSN :
- 0009-4773
- Volume :
- 54
- Issue :
- 5
- Database :
- MEDLINE
- Journal :
- Chirurgia italiana
- Publication Type :
- Academic Journal
- Accession number :
- 12469458