RT Journal Article
T1 Liver Trauma: Until When We Have to Delay Surgery? A Review.
A1 García, Inés Cañas
A1 Villalba, Julio Santoyo
A1 Iovino, Domenico
A1 Franchi, Caterina
A1 Iori, Valentina
A1 Pettinato, Giuseppe
A1 Inversini, Davide
A1 Amico, Francesco
A1 Ietto, Giuseppe
K1 DAMPs (damage-associated molecular patterns)
K1 DCS (damage control surgery)
K1 NETs (neutrophil extracellular traps)
K1 SIRS (systemic inflammatory response syndrome)
K1 liver regeneration
K1 liver trauma
K1 nonoperative management
AB Liver involvement after abdominal blunt trauma must be expected, and in up to 30% of cases, spleen, kidney, and pancreas injuries may coexist. Whenever hemodynamics conditions do not contraindicate the overcoming of the ancient dogma according to which exploratory laparotomy should be performed after every major abdominal trauma, a CT scan has to clarify the liver lesions so as to determine the optimal management strategy. Except for complete vascular avulsion, no liver trauma grade precludes nonoperative management. Every attempt to treat the injured liver by avoiding a strong surgical approach may be considered. Each time, a nonoperative management (NOM) consisting of a basic "wait and see" attitude combined with systemic support and blood replacement are inadequate. Embolization should be considered to stop the bleeding. Percutaneous drainage of collections, endoscopic retrograde cholangiopancreatography (ERCP) with papilla sphincterotomy or stent placement and percutaneous transhepatic biliary drainage (PTBD) may avoid, or at least delay, surgical reconstruction or resection until systemic and hepatic inflammatory remodeling are resolved. The pathophysiological principle sustaining these leanings is based on the opportunity to limit the further release of cell debris fragments acting as damage-associated molecular patterns (DAMPs) and the following stress response associated with the consequent immune suppression after trauma. The main goal will be a faster recovery combined with limited cell death of the liver through the ischemic events that may directly follow the trauma, exacerbated by hemostatic procedures and surgery, in order to reduce the gross distortion of a regenerated liver.
SN 2075-1729
YR 2022
FD 2022-05-06
LK http://hdl.handle.net/10668/21399
UL http://hdl.handle.net/10668/21399
LA en
DS RISalud
RD Apr 8, 2025