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Nonoperative management of high degree hepatic trauma in the patient with risk factors for failure: have we gone too far?

Background: Nonoperative management (NOM) of liver trauma is currently rather the rule than the exception. However, the current evidence presents subgroups of patients at higher risk for NOM failure. These patients must be treated more cautiously regarding the NOM approach. Method: A case report of...

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Detalles Bibliográficos
Autores principales: Beuran, M, Negoi, I, Ispas, AT, Păun, S, Runcanu, A, Lupu, G, Verter, D
Formato: Texto
Lenguaje:English
Publicado: Carol Davila University Press 2010
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3018996/
https://www.ncbi.nlm.nih.gov/pubmed/20945820
Descripción
Sumario:Background: Nonoperative management (NOM) of liver trauma is currently rather the rule than the exception. However, the current evidence presents subgroups of patients at higher risk for NOM failure. These patients must be treated more cautiously regarding the NOM approach. Method: A case report of 3 polytrauma patients (Injury Severity Score>17) with high–degree liver trauma managed nonoperatively. Results: The first case presented is the one of a polytrauma patient with degree Ⅳ liver injury and impaired mental status. It was a high risk for NOM failure because there was an angiographically hemostasis. The second case is one of a polytrauma patient who became hemodynamically stable after the administration of 2000 ml of fluid intravenously. There was a nonoperative approach with angiography and embolization of degree Ⅳ liver injury. Despite the success of the nonoperative treatment, there was an important hepatic necrosis following embolization. The third case is one of a polytrauma patient with a degree Ⅳ hepatic injury. Success was accomplished in NOM without an angiography. Conclusions: Nonoperative management of liver injuries can be applied safely even in high degree hepatic trauma. In hemodynamically metastable patients or impaired mental status patients, the nonoperative approach can be applied successfully, but the trauma surgeon must be very cautious.