Top

Published in:

Open Access 01-12-2015 | Review

Liver trauma: WSES position paper

Authors: Federico Coccolini, Giulia Montori, Fausto Catena, Salomone Di Saverio, Walter Biffl, Ernest E. Moore, Andrew B. Peitzman, Sandro Rizoli, Gregorio Tugnoli, Massimo Sartelli, Roberto Manfredi, Luca Ansaloni

Published in: World Journal of Emergency Surgery | Issue 1/2015

Abstract

The liver is the most injured organ in abdominal trauma. Road traffic crashes and antisocial, violent behavior account for the majority of liver injuries. The present position paper represents the position of the World Society of Emergency Surgery (WSES) about the management of liver injuries.

Richardson JD, Franklin GA, Lukan JK, Carrillo EH, Spain DA, Miller FB, et al. Evolution in the management of hepatic trauma: a 25-years perspective. Ann Surg. 2000;232:324–30.

Badger SA, Barclay R, Campbell P, Mole DJ, Diamond T. Management of liver trauma. World J Surg. 2009;33:2522–37.PubMed

Piper GL, Peitzman AB. Current management of hepatic trauma. Surg Clin N Am. 2010;90:775–85.PubMed

Peitzman AB, Richardson JD. Surgical treatment of injuries to the solid abdominal organs: a 50-years perspective from the Journal of Trauma. J of Trauma. 2010;69:1011–21.

Moore EE, Cogbill TH, Jurkovich GJ, Shackford SR, Malangoni MA, Champion HR. Organ injury scaling: spleen and liver (1994 revision). J Trauma. 1995;38:323–4.PubMed

Phillips B, Ball C, Sackett D, Badenoch D, Straus S, Haynes B, et al. Oxford Centre for Evidence-based Medicine Levels of Evidence. 2009.

Fabian TC, Bee TK. Ch.32 Liver and biliary tract. In: Feliciano DV, Mattox KL, Moore EE, editors. Trauma. 7th ed. 870: The McGraw-Hill Companies, Inc; 2013. p. 851.

Croce MA, Fabian TC, Menke PG, Waddle-Smith L, Minard G, Kudsk KA, et al. Nonoperative management of blunt hepatic trauma is the treatment of choice for hemodynamically stable patients. Results of a prospective trial. Ann Surg. 1995;221(6):744–53.PubMedPubMedCentral

Kozar RA, Feliciano VD, Moore EE, Moore FA, Cocanour CS, West MA, et al. Western trauma Association/Critical Decision in Trauma: Operative management of blunt Hepatic Trauma. J Trauma. 2011;71(1):1–5.PubMed

10.

Kumar S, Kumar A, Joshi MK, Rathi V. Comparison of diagnostic peritoneal lavage and focused assessment by sonography in trauma as an adjunct to primary survey in torso trauma: a prospective randomized clinical trial. Ulus Travma Acil Cerr Derg. 2014;20(2):101–6.

11.

Richards JR, McGahan JP, Pali MJ, Bohnen PA. Sonographic detection of blunt hepatic trauma : hemoperitoneum and parenchymal patterns of injury. J Trauma. 1999;47:1092.PubMed

12.

Sato M, Yoshii H. Reevaluation for ultrasonography for solid-organ injury in blunt abdominal trauma. J Ultrasound Med. 2004;23:158.

13.

Quinn AC, Sinert R. What is the utility of the Focused Assessment with Sonography in Trauma (FAST) exam in penetrating torso trauma? Injury. 2011;42(5):482–7.PubMed

14.

Kozar RA, Moore FA, Moore EE, West M, Cocanour CS, Davis J, et al. Western Trauma Association critical decisions in trauma: Nonoperative Management of adult blunt hepatic trauma. J Trauma. 2009;67:1144–49.PubMed

15.

Moore EE, Shackford SR, Pachter HL, McAninch JW, Browner BD, Champion HR et al. Organ injury scaling: spleen, liver, and kidney. J Trauma. 1989 Dec;29(12):1664-6.

16.

Chatoupis K, Papadopoulou G, Kaskarelis I. New technology in the management of liver trauma. Ann Gastroenterol. 2013;26(1):41–4.PubMedPubMedCentral

17.

Poletti PA, Mirvis SE, Shanmuganathan K, Killeen KL, Coldwell D. CT criteria for management of blunt liver trauma : correlation with angiography and surgical findings. Radiology. 2000;216:418–27.PubMed

18.

Gaarder C, Naess PA, Eken T, Skaga NO, Pillgram-Larsen J, Klow NE, et al. Liver injuries-Improved results with a formal protocol including angiography. Injury. 2007;38:1075–83.PubMed

19.

Hagiwara AT, Yukioka T, Ohta S, Tokunaga T, Ohta S, Matsuda H, et al. Nonsurgical management of patients with blunt hepatic injury: efficacy of transcatheter arterial embolization. AJR Am J Roentgenol. 1997;169:1151–6.PubMed

20.

Stassen NA, Bhullar I, Cheng JD, Crandall M, Friese R, Guillamondegui O, et al. Kerwin A; Eastern Association for the Surgery of Trauma. Non operative management of blunt hepatic injury: an Eastern association for the surgery of trauma practice management guideline. J Trauma Acute Care Surgery. 2012;73(5 Suppl 4):S288–93.

21.

Tinkoff G, Esposito T, Reed J, Kilgo P, Fildes J, Pasquale M, 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;207:646–55.PubMed

22.

Velmahos GC, Toutouzas K, Radin R, Chan L, Rhee P, Tillou A, et al. High success with non-operative management of blunt hepatic trauma : the live ris a sturdy organ. Arch Surg. 2003;138:475–80.PubMed

23.

Helling TS, Morse G, McNabney WK, Beggs CW, Behrends SH, Hutton-Rotert K, et al. Treatement of liver injuries at Level I and II centers in a multi-istitutional metropolitan trauma system. J Trauma. 1997;42:1091–96.PubMed

24.

Carrillo EH, Platz A, Miller FB, Richardson JD, Polk Jr HC. Non-operative management of blunt hepatic trauma. Br J Surg. 1998;85:461–68.PubMed

25.

Brasel KJ, DeLisle CM, Olson CJ, Borgstrom DC. Trends in the management of hepatic injury. Am J Surg. 1997;174:674–77.PubMed

26.

Coimbra R, Hoyt DB, Engelhart S, Fortlage D. Non-operative management reduces the overall mortality of Grade 3 and 4 of blunt liver injuries. Int Surg. 2006;91:251–57.PubMed

27.

Di Saverio S, Sibilio A, Coniglio C, Bianchi E, Biscardi A, Villani S, et al. A proposed algorithm for multimodal liver trauma management from a surgical trauma audit in a western European trauma center. Minerva Anestesiol. 2014;80(11):1205–16.PubMed

28.

Di Saverio S, Moore EE, Tugnoli G, Naidoo N, Ansaloni L, Bonilauri S, et al. Non operative management of liver and spleen traumatic injuries: a giant with clay feet. World J Emerg Surg. 2012;7(1):3.PubMedPubMedCentral

29.

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(3):626–9.PubMed

30.

American College of Surgeons. Advanced Trauma Life Support for Doctors (ATLS) Student Manual. 8th ed. 2008.

31.

Stein DM, Scalea TM. Nonoperative management of spleen and liver injuries. J Int Care Med. 2006;21:296.

32.

Fang JF, Wong YC, Lin BC, Hsu YP, Chen MF. The CT risk factors for the need of operative treatment on initially stable patients after blunt hepatic trauma. J Trauma. 2006;61:547–53.PubMed

33.

Fang JF, Chen RJ, Wong YC, Lin BC, Hsu YB, Kao JL, et al. Pooling of contrast material on computed tomography mandates aggressive management of blunt hepatic injury. Am J Surg. 1998;176:315–9.PubMed

34.

Poletti AP, Mirvis SE, Shanmuganathan K, Takada T, Killeen KL, Perlmutter D, et al. Blunt abdominal trauma patients: can organ injury be excluded without performing computer tomography? J Trauma. 2004;57:1072–81.PubMed

35.

Velmhaos GC, Toutouzas KG, Radin R, Chan L, Demetriades D. Nonoperative treatment of blunt injury to solid abdominal organs. Arch Surg. 2003;138:844.

36.

Yanar H, Ertekin C, Taviloglu K, Kabay B, Bakkaloglu H, Guloglu R. Nonoperative treatment of multiple intra-abdominal solid organ injury after blunt abdominal trauma. J Trauma. 2008;64(4):943–8.PubMed

37.

Pachter HL, Hofstetter SR. The current status of nonoperative management of adult blunt hepatic injuries. Am J Surg. 1995;169(4):442–54.PubMed

38.

Carillo E, Spain D, Wohltmann CD, Schmieg RE, Boaz PW, Miller FB, et al. Interventional techniques are useful adjuncts in nonoperative management of hepatic injuries. J Trauma. 1999;46:619.

39.

Kozar RA, Moore FA, Grade M, Szöke R, Liersch T, Becker H, et al. Risks factors for hepatic morbidity following nonoperative management. Arch Surg. 2006;141:451–8.PubMed

40.

Afshari A, Wikkelso A, Brok J, Møller AM, Wetterslev J. Thromboelatography (TEG) or thromboelastometry (ROTEM) to monitor haemotherapy versus usual care in patients with massive transfusion (Review). Cochrane Database Syst Rev. 2011;3:CD007871.PubMed

41.

Zatta A, Mcquilten Z, Kandane-Rathnayake R, Isbister J, Dunkley S, Mcneil J, et al. The Australian and New Zealand Haemostasis Registry: ten years of data on off-licence use of recombinant activated factor VII. Blood Transfus. 2015;13(1):86–99.PubMedPubMedCentral

42.

Hauser CJ, Boffard K, Dutton R, Bernard GR, Croce MA, Holcomb JB et al. Results of the CONTROL trial: efficacy and safety of recombinant activated Factor VII in the management of refractory traumatic hemorrhage. J Trauma. 2010 Sep;69(3):489–500.

43.

Wahl WL, Ahrns KS, Brandt MM, Franklin GA, Taheri PA. The need for early angiographic embolization in blunt hepatic injuries. J Trauma. 2002;52:1097–101.PubMed

44.

Mohr AM, Lavery RF, Barone A, Bahramipour P, Magnotti LJ, Osband AJ, et al. Angioembolization for liver injuries: low mortality, high morbidity. J Trauma. 2003;55(5):1077–81.PubMed

45.

Ward J, Alarcon L, Peitzman AB. Management of blunt liver injury: what is new? Eur J Trauma Emerg Surg. 2015 Jun;41(3):229-37.

46.

Hsieh TM, Tsai TC, Liang JL, Che LC. Non-operative management attempted for selective high grade blunt hepatosplenic trauma is a feasible strategy. WJES. 2014;9:51.PubMedPubMedCentral

47.

Van der Wilden GM, Velmhaos GC, Emhoff T, Brancato S, Adams C, Georgakis G, et al. Successful Nonoperative management of the most severe blunt liver injuries. Arch Surg. 2012;147(5):423–8.PubMed

48.

Marcheix B, Dambrin C, Cron C, Sledzianowski JF, Aguirre J, Suc B, et al. Transhepatic percutaneous embolisation of a post-traumatic pseudoaneurysm of hepatic artery. Ann Chir. 2004;129(10):603–6.PubMed

49.

Hommes M, Nicol AJ, Navsaria PH, Reinders Folmer E, Edu S, Krige JE. Management of biliary complications in 412 patients with liver injuries. J Trauma Acute Care Surg. 2014;77(3):448–51.PubMed

50.

Harrell DJ, Vitale GC, Larson GM. Selective role for endoscopic retrograde cholangiopancreatography in abdominal trauma. Surg Endosc. 1998;12(5):400–4.PubMed

51.

Letoublon C, Chen Y, Arvieux C, Voirin D, Morra I, Broux C, et al. Delayed celiotomy or laparoscopy as part of the nonoperative management of blunt hepatic trauma. Worls J Surg. 2008;32:1189–93.

52.

Carrillo EH, Wohltmann C, Richardson JD, Polk Jr HC. Evolution in the treatment of complex blunt liver injuries. Curr Probl Surg. 2001;38:1–60.PubMed

53.

Geerts WH, Jay RM, Code KI, Chen E, Szalai JP, Saibil EA, et al. A comparison of low-dose heparin with low-molecular-weight heparin as prophylaxis against venous thromboembolism after major trauma. NEJM. 1996;335(10):701–7.PubMed

54.

Datta I, Ball CG, Rudmik LR, Paton-Gay D, Bhayana D, Salat P, et al. A multicenter review of deep venous thrombosis prophylaxis practice patterns for blunt hepatic trauma. J Trauma Manag Outcomes. 2009;3:7.PubMedPubMedCentral

55.

Joseph B, Pandit V, Harrison C, Lubin D, Kulvatunyou N, Zangbar B, et al. Early thromboembolic prophylaxis in patients with blunt solid abdomen organ injuries undergoing nonoperative management: is it safe? Am J Surg. 2015;209(1):194–8.PubMed

56.

Demetriades D, Hadjizacharia P, Constantinou C, Brown C, Inaba K, Rhee P, et al. Selective nonoperative management of penetrating abdominal solid organ injuries. Ann Surg. 2006;244(4):620–8.PubMedPubMedCentral

57.

Navsaria PH, Nicol AJ, Krige JE, Edu S. Selective Nonoperative management of liver gunshot injuries. Ann Surg. 2009;249(4):653.PubMed

58.

Biffl WL, Leppaniemi A. Management Guidelines for Penetrating Abdominal Trauma. World J Surg. 2015;39(6):1373–80.PubMed

59.

Biffl WL, Kaups LK, Pham TN, Rowell SE, Jurkovich GJ, Burlew CC, et al. Validating the western trauma association algorithm managing patients with anterior abdominal stable wounds: a western trauma association multi center trial. J Trauma. 2011;71(6):1494–502.PubMed

60.

Biffl WL, Moore EE. Management guidelines for penetrating abdominal trauma. Curr Opin Crit Care. 2010;16(6):609–17.PubMed

61.

Biffl WL, Kaups KL, Cothren CC, Brasel KJ, Dicker RA, Bullard MK, et al. Management of patients with anterior abdominal stab wounds: a Western Trauma Association multicenter trial. J Trauma. 2009;66(5):1294–301.PubMed

62.

Sugrue M, Balogh Z, Lynch J, Bardsley J, Sisson G, Weigelt J. Guidelines for the management of haemodynamically stable patients with stab wounds to the anterior abdomen. ANZ J Surg. 2007;77(8):614–20.PubMed

63.

Lamb CM, Garner JP. Selective non-operative management of civilian gunshot wounds to the abdomen: a systematic review of the evidence. Injury. 2014;45(4):659–66.PubMed

64.

Velmahos GC, Constantinou C, Tillou A, Brown CV, Salim A, Demetriades D. Abdominal computed tomographic scan for patients with gunshot wounds to the abdomen selected for non-operative management. J Trauma. 2005;59(5):1155–60.PubMed

65.

Demetriades D, Rabinowitz B. Indications for operation in abdominal stab wounds. A prospective study of 651 patients. Ann Surg. 1987;205(2):129–32.PubMedPubMedCentral

66.

Demetriades D, Velmahos G. Indication for and technique of Laparotomy. In: Moore E, Feliciano D, Mattox K, editors. Trauma. 6th ed. New York: McGrraw-Hill; 2006.

67.

Letoublon C, Arvieux C. Traumatisme fermés du foie, Principes de technique et de tactique chirurgicales. EMC. Techniques chirurgicales – Appareil digestif, 40–785, 2003, 20 p.

68.

Letoublon C, Reche F, Abba J, Arvieux C. Damage control laparotomy. J Visc Surg. 2011;148(5):e366–70.PubMed

69.

Nicol AJ, Hommes M, Primrose R, Navsaria PH, Krige JE. Packing for control oh hemorrhage in major liver trauma. World J Surg. 2007;31:569–74.PubMed

70.

Di Saverio S, Catena F, Filicori F, Ansaloni L, Coccolini F, Keutgen XM, et al. Predictive factors of morbidity and mortality in grade IV and V liver trauma undergoing perihepatic packing: single institution 14 years experience at European trauma centre. Injury. 2012;43(9):1347–54.PubMed

71.

Baldoni F, Di Saverio S, Antonacci N, Coniglio C, Giugni A, Montanari N, et al. Refinement in the technique of peri-hepatic packing: a safe and effective surgical hemostasis and multidisciplinary approach can improve the outcome in severe liver trauma. Am J Surg. 2011;201(1):e5–e14.PubMed

72.

Filicori F, Di Saverio S, Casali M, Biscardi A, Baldoni F, Tugnoli G. Packing for damage control of nontraumatic intra-abdominal massive hemorrhages. World J Surg. 2010;34(9):2064–8.PubMed

73.

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(5):1032–6.PubMed

74.

Poggetti RS, Moore EE, Moore FA, Mitchell MB, Read RA. Balloon tamponade for bilobar transfixing hepatic gunshot wounds. J Trauma. 1992;33(5):694–7.PubMed

75.

Kram HB, Reuben BI, Fleming AW, Shoemaker WC. Use of Fibrin glue in hepatic trauma. J Trauma. 1988;45:1195.

76.

Holcomb JB, Pusateri AE, Harris RA, Charles NC, Gomez RR, Cole JP, et al. Effect of dry fibrin sealant dressing versus gauze packing on blood loss in grade V liver injuries in resuscitated swine. J Trauma. 1999;46:49.PubMed

77.

Sena MJ, Douglas G, Gerlach T, Grayson JK, Pichakron KO, Zierold D. A pilot study of the use of Kaolin-impregnated gauze (Combat Gauze) for packing high-grade hepatic injuries in a hypothermic coagulopathic swine model. J Surg Res. 2013;183(2):704–9.PubMed

78.

Strong RW, Lynch SV, Wall DR, Liu CL. Anatomic resection for severe liver trauma. Surgery. 1998;123:251–7.PubMed

79.

Polanco P, Stuart L, Pineda J, Puyana JC, Ochoa JB, Alarcon L, et al. Hepatic resection in the management of complex injury to the liver. J Trauma. 2008;65(6):1264–9.PubMed

80.

Peitzman AB, Marsh JW. Advanced operative techniques in management of complex liver injury. J Trauma Acute Care Surg. 2012;73(3):765–70.PubMed

81.

Richardson JD. Changes in the management of injuries to the liver and spleen. J Am Coll Surg. 2005 May;200(5):648-69.

82.

Frenklin GA, Casos SR. Current advances in the surgical approach to abdominal trauma. Injury. 2006;37:1143–56.

83.

Beal SL. Fatal hepatic hemorrhage: an unresolved problem in the management of complex liver injuries. J Trauma. 1990;30:163.PubMed

84.

Fabian TC, Croce MA, Stanford GG, Payne LW, Mangiante EC, Voeller GR, et al. Factors affecting morbidity following hepatic trauma. A prospective analysis od 482 injuries. Ann Surg. 1991;213:540.PubMedPubMedCentral

85.

Cue JI, Cryer HG, Miller FB, Richardson JD, Polk Jr HC. Packing and planned re-exploration for hepatic and retroperitoneal hemorrhage: critical refinements of a useful technique. J Trauma. 1990;30(8):1007.PubMed

86.

Biffl WL, Moore EE, Franciose RJ. Venovenous bypass and hepatic vascular isolation as adjuncts in the repair of destructive wounds to the retrohepatic inferior vena cava. J Trauma. 1998;45:400–3.PubMed

87.

Plackett TP, Barmparas G, Inaba K, Demetriades D. Transplantation for severe hepatic trauma. J Trauma. 2011;71(6):1880–4.PubMed

88.

Misselbeck TS, Teicher E, Cipolle MD, Pasquale MD, Shah KT, Dangleben DA, et al. Hepatic angioembolization in trauma patients:indications and complications. J Trauma. 2009;67:769–73.PubMed

89.

Johnson JW, Gracias VH, Gupta R, Guillamondegui O, Reilly PM, Shapiro MB, et al. Hepatic angiography in patients undergoing damage control laparotomy. J Trauma. 2002;52:1102–6.PubMed

90.

Asensio JA, Petrone P, García-Núñez L, Kimbrell B, Kuncir E. Multidisciplinary approach for the management of complex hepatic injuries AAST-OIS grades IV-V: a prospective study. Scand J Surg. 2007;96(3):214–20.PubMed

91.

Dabbs DN, Stein DM, Scalea TM. Major hepatic necrosis: a common complication after angioembolization for treatement of high grade injuries. J Trauma. 2009;66:621–7.PubMed

92.

Dabbs DN, Stein DM, Scalea TM. Major hepatic necrosis: a common complication after angioembolization for treatment of high-grade liver injuries. J Trauma. 2009 Mar;66(3):621-7; discussion 627-9.

Title: Liver trauma: WSES position paper
Authors: Federico Coccolini
Giulia Montori
Fausto Catena
Salomone Di Saverio
Walter Biffl
Ernest E. Moore
Andrew B. Peitzman
Sandro Rizoli
Gregorio Tugnoli
Massimo Sartelli
Roberto Manfredi
Luca Ansaloni
Publication date: 01-12-2015
Publisher: BioMed Central
Published in: World Journal of Emergency Surgery / Issue 1/2015
Electronic ISSN: 1749-7922
DOI: https://doi.org/10.1186/s13017-015-0030-9

Keynote webinar | Spotlight on sleep in brain health

Springer Medicine

Liver trauma: WSES position paper

Abstract

Keynote webinar | Spotlight on sleep in brain health

Springer Medicine

Abstract

Please log in to get access to this content

Other articles of this Issue 1/2015

Can we respect the principles of oncologic resection in an emergency surgery to treat colon cancer?

Foregut caustic injuries: results of the world society of emergency surgery consensus conference

Elevated white blood cell count, decreased hematocrit and presence of macrohematuria correlate with abdominal organ injury in pediatric blunt trauma patients: a retrospective study

Non operative management of traumatic esophageal perforation leading to esophagocutaneous fistula in pediatric age group: review and case report

Etiology, treatment outcome and prognostic factors among patients with secondary peritonitis at Bugando Medical Centre, Mwanza, Tanzania

Severe mutilating injuries with complex macroamputations of the upper extremity – is it worth the effort?