I traumi epatici: esperienza di trattamento di 252 casi.

Translated title of the contribution: Liver trauma: experience in the management of 252 cases

Fabio Colombo, Fabio Sansonna, Fabio Baticci, Rocco Corso, Ildo Scandroglio, Dario Maggioni, Stefano Di Lernia, Giovanni Carlo Ferrari, Carmelo Magistro, Andrea Costanzi, Raffaele Pugliese

Research output: Contribution to journalArticle

Abstract

The treatment of liver traumas has evolved considerably over recent decades with the possibility of non-operative management and arteriographic embolisation for selected patients in haemodynamically stable conditions. The aim of the study was to compare two periods with different approaches to the management of blunt or penetrating liver injuries. From January 1989 to October 2004, 252 patients were admitted to the emergency surgery department of Niguarda Hospital in Milan for liver traumas. Hepatic lesions accounted for 66% of abdominal lesions due to trauma and were classified according to the Organ Injury Scaling system. Abdominal ultrasound and CT scans were used to investigate the injuries. The study consisted of two periods: during the first period (1989-1993) surgery was the only treatment for trauma-induced hepatic lesions of any grade. Damage control surgery was employed for unstable patients undergoing laparotomy. From 1994 on, grade 1-2 injuries in patients with haemodynamically stable conditions were treated by non-operative management and grade 3 injuries by embolisation. In this second period only unstable patients with active bleeding or haemoperitoneum >500 ml with grade 3-5 injuries underwent laparotomy. The overall mortality for liver traumas was 27% (68/252) and was intraoperative in 97% of cases (66/68). Deaths were due to liver haemorrhage in 30 cases and to bleeding from extrahepatic or extra-abdominal injuries in the other 38 cases. Liver trauma was therefore directly responsible for mortality in as many as 12% of cases (30/252). The present study analysed two periods characterised by different approaches to the management of liver trauma. In the first period, laparotomy was the only choice, whereas subsequently non-operative management came to play an important role in haemodynamically stable patients and proved to be a safe method in selected cases. Major liver resections are seldom indicated in liver injuries. Damage control surgery has been practised since the first period and, before any surgical manoeuvres are performed, still represents a valuable tool to guarantee haemodynamic stability, which is the crucial factor for the outcome of liver resections for trauma.

Original languageItalian
Pages (from-to)695-702
Number of pages8
JournalChirurgia Italiana
Volume57
Issue number6
Publication statusPublished - Nov 2005

Fingerprint

Case Management
Liver
Wounds and Injuries
Laparotomy
Hemorrhage
Hemoperitoneum
Abdominal Injuries
Mortality
Hospital Emergency Service

ASJC Scopus subject areas

  • Surgery

Cite this

Colombo, F., Sansonna, F., Baticci, F., Corso, R., Scandroglio, I., Maggioni, D., ... Pugliese, R. (2005). I traumi epatici: esperienza di trattamento di 252 casi. Chirurgia Italiana, 57(6), 695-702.

I traumi epatici : esperienza di trattamento di 252 casi. / Colombo, Fabio; Sansonna, Fabio; Baticci, Fabio; Corso, Rocco; Scandroglio, Ildo; Maggioni, Dario; Di Lernia, Stefano; Ferrari, Giovanni Carlo; Magistro, Carmelo; Costanzi, Andrea; Pugliese, Raffaele.

In: Chirurgia Italiana, Vol. 57, No. 6, 11.2005, p. 695-702.

Research output: Contribution to journalArticle

Colombo, F, Sansonna, F, Baticci, F, Corso, R, Scandroglio, I, Maggioni, D, Di Lernia, S, Ferrari, GC, Magistro, C, Costanzi, A & Pugliese, R 2005, 'I traumi epatici: esperienza di trattamento di 252 casi.', Chirurgia Italiana, vol. 57, no. 6, pp. 695-702.
Colombo F, Sansonna F, Baticci F, Corso R, Scandroglio I, Maggioni D et al. I traumi epatici: esperienza di trattamento di 252 casi. Chirurgia Italiana. 2005 Nov;57(6):695-702.
Colombo, Fabio ; Sansonna, Fabio ; Baticci, Fabio ; Corso, Rocco ; Scandroglio, Ildo ; Maggioni, Dario ; Di Lernia, Stefano ; Ferrari, Giovanni Carlo ; Magistro, Carmelo ; Costanzi, Andrea ; Pugliese, Raffaele. / I traumi epatici : esperienza di trattamento di 252 casi. In: Chirurgia Italiana. 2005 ; Vol. 57, No. 6. pp. 695-702.
@article{fac79e03d6cd41fa9d89d41f7857ae81,
title = "I traumi epatici: esperienza di trattamento di 252 casi.",
abstract = "The treatment of liver traumas has evolved considerably over recent decades with the possibility of non-operative management and arteriographic embolisation for selected patients in haemodynamically stable conditions. The aim of the study was to compare two periods with different approaches to the management of blunt or penetrating liver injuries. From January 1989 to October 2004, 252 patients were admitted to the emergency surgery department of Niguarda Hospital in Milan for liver traumas. Hepatic lesions accounted for 66{\%} of abdominal lesions due to trauma and were classified according to the Organ Injury Scaling system. Abdominal ultrasound and CT scans were used to investigate the injuries. The study consisted of two periods: during the first period (1989-1993) surgery was the only treatment for trauma-induced hepatic lesions of any grade. Damage control surgery was employed for unstable patients undergoing laparotomy. From 1994 on, grade 1-2 injuries in patients with haemodynamically stable conditions were treated by non-operative management and grade 3 injuries by embolisation. In this second period only unstable patients with active bleeding or haemoperitoneum >500 ml with grade 3-5 injuries underwent laparotomy. The overall mortality for liver traumas was 27{\%} (68/252) and was intraoperative in 97{\%} of cases (66/68). Deaths were due to liver haemorrhage in 30 cases and to bleeding from extrahepatic or extra-abdominal injuries in the other 38 cases. Liver trauma was therefore directly responsible for mortality in as many as 12{\%} of cases (30/252). The present study analysed two periods characterised by different approaches to the management of liver trauma. In the first period, laparotomy was the only choice, whereas subsequently non-operative management came to play an important role in haemodynamically stable patients and proved to be a safe method in selected cases. Major liver resections are seldom indicated in liver injuries. Damage control surgery has been practised since the first period and, before any surgical manoeuvres are performed, still represents a valuable tool to guarantee haemodynamic stability, which is the crucial factor for the outcome of liver resections for trauma.",
author = "Fabio Colombo and Fabio Sansonna and Fabio Baticci and Rocco Corso and Ildo Scandroglio and Dario Maggioni and {Di Lernia}, Stefano and Ferrari, {Giovanni Carlo} and Carmelo Magistro and Andrea Costanzi and Raffaele Pugliese",
year = "2005",
month = "11",
language = "Italian",
volume = "57",
pages = "695--702",
journal = "Chirurgia Italiana",
issn = "0009-4773",
publisher = "Bi & Gi Editori",
number = "6",

}

TY - JOUR

T1 - I traumi epatici

T2 - esperienza di trattamento di 252 casi.

AU - Colombo, Fabio

AU - Sansonna, Fabio

AU - Baticci, Fabio

AU - Corso, Rocco

AU - Scandroglio, Ildo

AU - Maggioni, Dario

AU - Di Lernia, Stefano

AU - Ferrari, Giovanni Carlo

AU - Magistro, Carmelo

AU - Costanzi, Andrea

AU - Pugliese, Raffaele

PY - 2005/11

Y1 - 2005/11

N2 - The treatment of liver traumas has evolved considerably over recent decades with the possibility of non-operative management and arteriographic embolisation for selected patients in haemodynamically stable conditions. The aim of the study was to compare two periods with different approaches to the management of blunt or penetrating liver injuries. From January 1989 to October 2004, 252 patients were admitted to the emergency surgery department of Niguarda Hospital in Milan for liver traumas. Hepatic lesions accounted for 66% of abdominal lesions due to trauma and were classified according to the Organ Injury Scaling system. Abdominal ultrasound and CT scans were used to investigate the injuries. The study consisted of two periods: during the first period (1989-1993) surgery was the only treatment for trauma-induced hepatic lesions of any grade. Damage control surgery was employed for unstable patients undergoing laparotomy. From 1994 on, grade 1-2 injuries in patients with haemodynamically stable conditions were treated by non-operative management and grade 3 injuries by embolisation. In this second period only unstable patients with active bleeding or haemoperitoneum >500 ml with grade 3-5 injuries underwent laparotomy. The overall mortality for liver traumas was 27% (68/252) and was intraoperative in 97% of cases (66/68). Deaths were due to liver haemorrhage in 30 cases and to bleeding from extrahepatic or extra-abdominal injuries in the other 38 cases. Liver trauma was therefore directly responsible for mortality in as many as 12% of cases (30/252). The present study analysed two periods characterised by different approaches to the management of liver trauma. In the first period, laparotomy was the only choice, whereas subsequently non-operative management came to play an important role in haemodynamically stable patients and proved to be a safe method in selected cases. Major liver resections are seldom indicated in liver injuries. Damage control surgery has been practised since the first period and, before any surgical manoeuvres are performed, still represents a valuable tool to guarantee haemodynamic stability, which is the crucial factor for the outcome of liver resections for trauma.

AB - The treatment of liver traumas has evolved considerably over recent decades with the possibility of non-operative management and arteriographic embolisation for selected patients in haemodynamically stable conditions. The aim of the study was to compare two periods with different approaches to the management of blunt or penetrating liver injuries. From January 1989 to October 2004, 252 patients were admitted to the emergency surgery department of Niguarda Hospital in Milan for liver traumas. Hepatic lesions accounted for 66% of abdominal lesions due to trauma and were classified according to the Organ Injury Scaling system. Abdominal ultrasound and CT scans were used to investigate the injuries. The study consisted of two periods: during the first period (1989-1993) surgery was the only treatment for trauma-induced hepatic lesions of any grade. Damage control surgery was employed for unstable patients undergoing laparotomy. From 1994 on, grade 1-2 injuries in patients with haemodynamically stable conditions were treated by non-operative management and grade 3 injuries by embolisation. In this second period only unstable patients with active bleeding or haemoperitoneum >500 ml with grade 3-5 injuries underwent laparotomy. The overall mortality for liver traumas was 27% (68/252) and was intraoperative in 97% of cases (66/68). Deaths were due to liver haemorrhage in 30 cases and to bleeding from extrahepatic or extra-abdominal injuries in the other 38 cases. Liver trauma was therefore directly responsible for mortality in as many as 12% of cases (30/252). The present study analysed two periods characterised by different approaches to the management of liver trauma. In the first period, laparotomy was the only choice, whereas subsequently non-operative management came to play an important role in haemodynamically stable patients and proved to be a safe method in selected cases. Major liver resections are seldom indicated in liver injuries. Damage control surgery has been practised since the first period and, before any surgical manoeuvres are performed, still represents a valuable tool to guarantee haemodynamic stability, which is the crucial factor for the outcome of liver resections for trauma.

UR - http://www.scopus.com/inward/record.url?scp=33644871836&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=33644871836&partnerID=8YFLogxK

M3 - Articolo

C2 - 16400763

AN - SCOPUS:33644871836

VL - 57

SP - 695

EP - 702

JO - Chirurgia Italiana

JF - Chirurgia Italiana

SN - 0009-4773

IS - 6

ER -