Author/Authors :
özçinar, beyza istanbul faculty of medicine - department of general surgery, Turkey , yanar, hakan t. istanbul faculty of medicine - department of general surgery, Turkey , sivrikoz, emre istanbul faculty of medicine - department of general surgery, Turkey , yanar, fatih istanbul faculty of medicine - department of general surgery, Turkey , sarici, inanç s. istanbul faculty of medicine - department of general surgery, Turkey , uçar, adem istanbul faculty of medicine - department of radiology, Turkey , günay, kayıhan istanbul faculty of medicine - department of general surgery, Turkey , güloğlu, recep istanbul faculty of medicine - department of general surgery, Turkey , ertekin, cemalettin istanbul faculty of medicine - department of general surgery, Turkey , kurtoğlu, mehmet istanbul faculty of medicine - department of general surgery, Turkey
Abstract :
Objective: The management of traumatic liver injuries involves various strategies ranging from observation to operative intervention and includes various options such as angiography and/or damage-control surgery. In this study, we aimed to clarify whether routine angiography is necessary or can be reserved for selected patients with persistent bleeding after depacking. Methods: During the 11-year period from January 2000 to December 2010 all patients with blunt or penetrating trauma who sustained a liver injury and underwent a damage control laparotomy in our institution were retrospectively reviewed. Following variables were extracted from patient charts: demographics, the mechanism of injury, shock status, Injury Severity Score, liver injury grades, associated injuries, angioembolization, duration of hospitalisation, time to depacking, mortality. Angioembolization.was performed when persistent bleeding was encountered after depacking. Results: A total of 513 patients with hepatic injury were admitted during the study period. Damage control surgery was undertaken in 60 patients, of whom 21 patients underwent angioembolization. The factors associated with a high Injury Severity Score were admission in shock status (p=0.009) and associated organ injuries (p 0.001). Extremity injury was the most commonly encountered associated injury (n=15, 25.0%). In the damage control surgery group, mortality was not significantly different between angioembolization (n=4, 19%) and non-angioembolization (n=14, 33%) groups (p=0.369). Conclusion: The most patients with abdominal packing after liver trauma may not require routine angiography. Angioembolization may be used selectively in patients with persistent bleeding after depacking.
NaturalLanguageKeyword :
Angiography , embolisation , trauma , packing
