Semin intervent Radiol 2020; 37(01): 035-043
DOI: 10.1055/s-0039-3401838
Review Article
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Contemporary Management of Hepatic Trauma: What IRs Need to Know

Shenise Gilyard
1   Division of Interventional Radiology and Image-Guided Medicine, Department of Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, Georgia
,
Kaitlin Shinn
2   Department of Medical Education, Emory University School of Medicine, Atlanta, Georgia
,
Nariman Nezami
3   Division of Vascular and Interventional Radiology, Department of Radiology and Radiological Science, Johns Hopkins School of Medicine, Baltimore, Maryland
,
Laura K. Findeiss
1   Division of Interventional Radiology and Image-Guided Medicine, Department of Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, Georgia
,
Sean Dariushnia
1   Division of Interventional Radiology and Image-Guided Medicine, Department of Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, Georgia
,
April A. Grant
4   Division of Trauma/Surgical Critical Care, Department of Surgery, Emory University School of Medicine, Atlanta, Georgia
,
C. Matthew Hawkins
1   Division of Interventional Radiology and Image-Guided Medicine, Department of Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, Georgia
,
Gail L. Peters
1   Division of Interventional Radiology and Image-Guided Medicine, Department of Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, Georgia
,
Bill S. Majdalany
1   Division of Interventional Radiology and Image-Guided Medicine, Department of Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, Georgia
,
Janice Newsome
1   Division of Interventional Radiology and Image-Guided Medicine, Department of Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, Georgia
,
Zachary L. Bercu
1   Division of Interventional Radiology and Image-Guided Medicine, Department of Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, Georgia
,
Nima Kokabi
1   Division of Interventional Radiology and Image-Guided Medicine, Department of Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, Georgia
› Author Affiliations
Further Information

Publication History

Publication Date:
04 March 2020 (online)

Abstract

Trauma remains one of the leading causes of death in the United States in patients younger than 45 years. Blunt trauma is most commonly a result of high-speed motor vehicular collisions or high-level fall. The liver and spleen are the most commonly injured organs, with the liver being the most commonly injured organ in adults and the spleen being the most affected in pediatric blunt trauma. Liver injuries incur a high level of morbidity and mortality mostly secondary to hemorrhage. Over the past 20 years, angiographic intervention has become a mainstay of treatment of hepatic trauma. As there is an increasing need for the interventional radiologists to embolize active hemorrhage in the setting of blunt and penetrating hepatic trauma, this article aims to review the current level of evidence and contemporary management of hepatic trauma from the perspective of interventional radiologists. Embolization techniques and associated outcome and complications are also reviewed.

 
  • References

  • 1 Boese CK, Hackl M, Müller LP, Ruchholtz S, Frink M, Lechler P. Nonoperative management of blunt hepatic trauma: a systematic review. J Trauma Acute Care Surg 2015; 79 (04) 654-660
  • 2 Chang MC. , et al. ed. National Trauma Data Bank 2016 Pediatric Annual Report. American College of Surgeons 2016. . Available at: https://www.facs.org/~/media/files/quality%20programs/trauma/ntdb/ntdb%20pediatric%20annual%20report%202016.ashx . Accessed January 30, 2020
  • 3 Vo NJ, Althoen M, Hippe DS, Prabhu SJ, Valji K, Padia SA. Pediatric abdominal and pelvic trauma: safety and efficacy of arterial embolization. J Vasc Interv Radiol 2014; 25 (02) 215-220
  • 4 Gates RL, Price M, Cameron DB. , et al. Non-operative management of solid organ injuries in children: an American Pediatric Surgical Association Outcomes and Evidence Based Practice Committee systematic review. J Pediatr Surg 2019; 54 (08) 1519-1526
  • 5 Fodor M, Primavesi F, Morell-Hofert D. , et al. Non-operative management of blunt hepatic and splenic injury: a time-trend and outcome analysis over a period of 17 years. World J Emerg Surg 2019; 14: 29
  • 6 Hommes M, Navsaria PH, Schipper IB, Krige JE, Kahn D, Nicol AJ. Management of blunt liver trauma in 134 severely injured patients. Injury 2015; 46 (05) 837-842
  • 7 Parks NA, Davis JW, Forman D, Lemaster D. Observation for nonoperative management of blunt liver injuries: how long is long enough?. J Trauma 2011; 70 (03) 626-629
  • 8 Letoublon C, Morra I, Chen Y, Monnin V, Voirin D, Arvieux C. Hepatic arterial embolization in the management of blunt hepatic trauma: indications and complications. J Trauma 2011; 70 (05) 1032-1036 , discussion 1036–1037
  • 9 Carver D, Kirkpatrick AW, D'Amours S, Hameed SM, Beveridge J, Ball CG. A prospective evaluation of the utility of a hybrid operating suite for severely injured patients: overstated or underutilized?. Ann Surg 2018 . Doi: 10.1097/SLA.0000000000003175. [Epub ahead of print]
  • 10 Linnaus ME, Langlais CS, Garcia NM. , et al. Failure of nonoperative management of pediatric blunt liver and spleen injuries: a prospective Arizona-Texas-Oklahoma-Memphis-Arkansas Consortium study. J Trauma Acute Care Surg 2017; 82 (04) 672-679
  • 11 Letoublon C, Amariutei A, Taton N. , et al. Management of blunt hepatic trauma. J Visc Surg 2016; 153 (4, Suppl): 33-43
  • 12 Cook A, Weddle J, Baker S. , et al. A comparison of the injury severity score and the trauma mortality prediction model. J Trauma Acute Care Surg 2014; 76 (01) 47-52 , discussion 52–53
  • 13 Loftis KL, Price J, Gillich PJ. Evolution of the abbreviated injury scale: 1990–2015. Traffic Inj Prev 2018; 19: S109-S113
  • 14 Moore EE, Cogbill TH, Jurkovich GJ, Shackford SR, Malangoni MA, Champion HR. Organ injury scaling: spleen and liver (1994 revision). J Trauma 1995; 38 (03) 323-324
  • 15 Coccolini F, Catena F, Moore EE. , et al. WSES classification and guidelines for liver trauma. World J Emerg Surg 2016; 11 (01) 50
  • 16 Fodor M, Primavesi F, Morell-Hofert D. , et al. Non-operative management of blunt hepatic and splenic injuries-practical aspects and value of radiological scoring systems. Eur Surg 2018; 50 (06) 285-298
  • 17 Schellenberg M, Benjamin E, Piccinini A, Inaba K, Demetriades D. Gunshot wounds to the liver: no longer a mandatory operation. J Trauma Acute Care Surg 2019; 87 (02) 350-355
  • 18 Inchingolo R, Ljutikov A, Deganello A, Kane P, Karani J. Outcomes and indications for intervention in non-operative management of paediatric liver trauma: a 5 year retrospective study. Clin Radiol 2014; 69 (02) 157-162
  • 19 Prichayudh S, Sirinawin C, Sriussadaporn S. , et al. Management of liver injuries: predictors for the need of operation and damage control surgery. Injury 2014; 45 (09) 1373-1377
  • 20 David Richardson J, Franklin GA, Lukan JK. , et al. Evolution in the management of hepatic trauma: a 25-year perspective. Ann Surg 2000; 232 (03) 324-330
  • 21 Asensio JA, Demetriades D, Chahwan S. , et al. Approach to the management of complex hepatic injuries. J Trauma 2000; 48 (01) 66-69
  • 22 Sivrikoz E, Teixeira PG, Resnick S, Inaba K, Talving P, Demetriades D. Angiointervention: an independent predictor of survival in high-grade blunt liver injuries. Am J Surg 2015; 209 (04) 742-746
  • 23 Kiankhooy A, Sartorelli KH, Vane DW, Bhave AD. Angiographic embolization is safe and effective therapy for blunt abdominal solid organ injury in children. J Trauma 2010; 68 (03) 526-531
  • 24 Coccolini F, Montori G, Catena F. , et al. Liver trauma: WSES position paper. World J Emerg Surg 2015; 10 (01) 39
  • 25 Malhotra AK, Fabian TC, Croce MA. , et al. Blunt hepatic injury: a paradigm shift from operative to nonoperative management in the 1990s. Ann Surg 2000; 231 (06) 804-813
  • 26 Tinkoff G, Esposito TJ, Reed J. , et al. American Association for the Surgery of Trauma Organ Injury Scale I: spleen, liver, and kidney, validation based on the National Trauma Data Bank. J Am Coll Surg 2008; 207 (05) 646-655
  • 27 Matsumoto S, Cantrell E, Jung K, Smith A, Coimbra R. Influence of postoperative hepatic angiography on mortality after laparotomy in Grade IV/V hepatic injuries. J Trauma Acute Care Surg 2018; 85 (02) 290-297
  • 28 Samuels JM, Urban S, Peltz E. , et al. A modern, multicenter evaluation of hepatic angioembolization - Complications and readmissions persist. Am J Surg 2019 Doi: 10.1016/j.amjsurg.2019.06.021. [Epub ahead of print]
  • 29 Martin JG, Shah J, Robinson C, Dariushnia S. Evaluation and management of blunt solid organ trauma. Tech Vasc Interv Radiol 2017; 20 (04) 230-236
  • 30 Kataoka Y, Minehara H, Kashimi F. , et al. Hybrid treatment combining emergency surgery and intraoperative interventional radiology for severe trauma. Injury 2016; 47 (01) 59-63
  • 31 Kohler JE, Chokshi NK. Management of abdominal solid organ injury after blunt trauma. Pediatr Ann 2016; 45 (07) e241-e246
  • 32 Jeavons C, Hacking C, Beenen LF, Gunn ML. A review of split-bolus single-pass CT in the assessment of trauma patients. Emerg Radiol 2018; 25 (04) 367-374
  • 33 Iacobellis FSM, Brillantino A, Scuderi MG. , et al. The additional value of the arterial phase in the CT assessment of liver vascular injuries after high-energy blunt trauma. Emerg Radiol 2019; 26 (06) 647-654
  • 34 Marovic P, Beech PA, Koukounaras J, Kavnoudias H, Goh GS. Accuracy of dual bolus single acquisition computed tomography in the diagnosis and grading of adult traumatic splenic parenchymal and vascular injury. J Med Imaging Radiat Oncol 2017; 61 (06) 725-731
  • 35 Monzer A, Chehab AS, Tulin-Silver S. , et al. Practice guideline for adult antibiotic prophylaxis during vascular and interventional radiology procedures. J Vasc Interv Radiol 2011; 22 (02) 263
  • 36 Stainken B. Trauma management. In: Kandarpa K, Machan L, Durham J. , eds. Handbook of Interventional Radiologic Procedures. Wolters Kluwer Health; 2016
  • 37 Covey AM, Brody LA, Maluccio MA, Getrajdman GI, Brown KT. Variant hepatic arterial anatomy revisited: digital subtraction angiography performed in 600 patients. Radiology 2002; 224 (02) 542-547
  • 38 Winter III TC, Nghiem HV, Freeny PC, Hommeyer SC, Mack LA. Hepatic arterial anatomy: demonstration of normal supply and vascular variants with three-dimensional CT angiography. Radiographics 1995; 15 (04) 771-780
  • 39 Durkin N, Deganello A, Sellars ME, Sidhu PS, Davenport M, Makin E. Post-traumatic liver and splenic pseudoaneurysms in children: diagnosis, management and follow-up screening using contrast-enhanced ultrasound (CEUS). J Pediatr Surg 2016; 51 (02) 289-292
  • 40 Darcy M. Acute Gastrointestinal hemorrhage. In: Kandarpa K, Machan L, Durham J. , eds. Handbook of Interventional Radiologic Procedures. Wolters Kluwer Health; 2019: 232
  • 41 Medsinge A, Zajko A, Orons P, Amesur N, Santos E. A case-based approach to common embolization agents used in vascular interventional radiology. AJR Am J Roentgenol 2014; 203 (04) 699-708
  • 42 Vanninen RL, Manninen I. Onyx, a new liquid embolic material for peripheral interventions: preliminary experience in aneurysm, pseudoaneurysm, and pulmonary arteriovenous malformation embolization. Cardiovasc Intervent Radiol 2007; 30 (02) 196-200
  • 43 Mohr AM, Lavery RF, Barone A. , et al. Angiographic embolization for liver injuries: low mortality, high morbidity. J Trauma 2003; 55 (06) 1077-1081 , discussion 1081–1082
  • 44 reen CS, Bulger EM, Kwan SW. Outcomes and complications of angioembolization for hepatic trauma: a systematic review of the literature. J Trauma Acute Care Surg 2016; 80 (03) 529-537
  • 45 Nezami N, Jarmakani H, Arici M. , et al. Selective trans-catheter coil embolization of cystic duct stump in post-cholecystectomy bile leak. Dig Dis Sci 2019; 64 (11) 3314-3320
  • 46 Sacks D, Ong A, Fernandez F. Percutaneous debridement of posttraumatic infected major hepatic necrosis. J Vasc Interv Radiol 2014; 25 (08) 1273-1277
  • 47 Hsu CP, Wang SY, Hsu YP. , et al. Risk factors for liver abscess formation in patients with blunt hepatic injury after non-operative management. Eur J Trauma Emerg Surg 2014; 40 (05) 547-552
  • 48 Lardière-Deguelte S, Ragot E, Amroun K. , et al. Hepatic abscess: diagnosis and management. J Visc Surg 2015; 152 (04) 231-243