Keywords
Trauma
Damage control
Non-operative management
Angioembolization
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Abstract
Objective: To analyze strategies and interventions in damage control for liver trauma, identifying effective approaches and the main challenges in initial management and subsequent treatment phases. Methods: An integrative review was conducted through a search in the PubMed Central (PMC) database, including 13 articles addressing damage control in liver trauma, published between 2019 and 2024, in English and Spanish. Results: Nonoperative management (NOM) proved effective, particularly in hemodynamically stable patients with minor liver injuries, showing high success rates and reduced hospitalization time. However, severe cases (grade IV or V), significant hemoperitoneum, and the need for angioembolization were associated with an increased risk of NOM failure, indicating the necessity of surgical intervention. Angioembolization and hepatic packing emerged as complementary techniques to control hemorrhage and stabilize patients. Conclusions: A multidisciplinary and individualized approach is essential in liver trauma management. NOM is effective in most cases, but proper patient selection and the availability of additional strategies are crucial to improving clinical outcomes.
References
ALANEZI T, et al. Management and Outcomes of Traumatic Liver Injury: A Retrospective Analysis from a Tertiary Care Center Experience. In: Healthcare. MDPI, 2024; 12(2): 131.
AYDIN O, et al. May dexpanthenol, platelet-rich plasma, and thymoquinone provide new hope to maintain liver regeneration after partial hepatectomy? The Turkish Journal of Gastroenterology, 2019; 30(9): 826.
BELTZER C, et al. Use of angioembolization, treatment modalities and mortality in association with blunt liver trauma in Germany—a data analysis of the TraumaRegister DGU®. Langenbeck's archives of surgery, 2023; 409(1): 6.
CARTU D, et al. Nonoperative treatment of abdominal trauma involving liver and spleen. Chirurgia, 2021; 116(6): 689-699.
DEL VALLE FJS, et al. Construction and validation of a novel and severe hepatic injury model in swine focuses on research and training. Observational study. MethodsX, 2023; 11: 102362.
FODOR M, et al. Non-operative management of blunt hepatic and splenic injury: a time-trend and outcome analysis over a period of 17 years. World Journal of Emergency Surgery, 2019; 14: 1-12.
GARCÍA IC, et al. Liver trauma: until when we have to delay surgery? A review. Life, 2022; 12(5): 694.
HOWLEY I, et al. Outcomes and complications for portal vein or superior mesenteric vein injury: no improvement in the era of damage control resuscitation. Injury, 2019; 50(12): 2228-2233.
HU W, et al. Accident-related hepatic trauma in a medical clinical center in eastern China: a cross-sectional study. BMC surgery, 2021; 21: 1-9.
KANANI A, et al. Management of severe liver injuries: push, pack, pringle–and plug!. Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine, 2021; 29: 1-4.
KEIZER AA, et al. Blunt and penetrating liver trauma have similar outcomes in the modern era. Scandinavian Journal of Surgery, 2021; 110(2): 208-213.
KRUGER A, et al. Damage control laparotomy outcomes in a major urban trauma centre. South African Journal of Surgery, 2022; 60(2): 84-90.
LIN BC, et al. Surgical management and outcome of blunt major liver injuries: experience of damage control laparotomy with perihepatic packing in one trauma centre. Injury, 2014; 45(1):122-127.
MALIK MM, et al. Delayed presentation of severe blunt liver trauma following a 12-foot fall: a case report of a grade 4 hepatic injury with a concurrent grade 1 renal injury. Cureus, 2024; 16(4).
ORDOÑEZ CA, et al. Damage control in penetrating liver trauma: fear of the unknown. Colombia Médica, 2020; 51(4).
PILLAI AS, et al. Hepatic trauma interventions. In: Seminars in interventional radiology. Thieme Medical Publishers, Inc., 2021; 38(1): 096-0104.
ROUY M, et al. Predictive factors of non-operative management failure in 494 blunt liver injuries: a multicenter retrospective study. Updates in Surgery, 2022; 74(6): 1901-1913.
RUSCELLI P, et al. The role of grade of injury in non-operative management of blunt hepatic and splenic trauma: Case series from a multicenter experience. Medicine, 2019; 98(35): e16746.
SCHEMBARI E, et al. Blunt liver trauma: effectiveness and evolution of non-operative management (NOM) in 145 consecutive cases. Updates in surgery, 2020; 72: 1065-1071.
STREITH L, et al. Optimal treatments for hepato-pancreato-biliary trauma in severely injured patients: a narrative scoping review. Canadian Journal of Surgery, 2020; 63(5): e431.