Il trattamento non operatorio delle lesioni traumatiche del fegato

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Osvaldo Chiara, Stefania Cimbanassi, Roberto Bini, Lucia Pavesi^, Antonio Rampoldi, Fabio Colombo, Fabio Sansonna, Raffaele Pugliese

Ann. Ital. Chir., 2005; 76: 161-165

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BACKGROUND: Nonoperative management (TNO) of traumatic liver injury is the choice in hemodinamically stable patients
without other abdominal injuries requiring celiotomy, apart from liver injury grading and amount of free peritoneal
bood. CT-scan and angiographic embolization availability increase TNO feasibility.
AIMS: To investigate feasibility of TNO in 16-months period consecutive liver injuries.
MATERIALS AND METHODS: All data of severe trauma patients admitted to our facility during the study period were recorded.
Clinical decision scheme of our facility indicates TNO in hemodynamically stable patients with liver injury and no
need for celiotomy. CT-scan is performed and injury grading evaluated. Angiographic embolization is done if contrast medium
extravasation is present at CT-scan. Laparoscopy is suggested if ongoing bleeding with negative CT-scan for blushing.
RESULTS: Liver injury was detected in 34 of 452 severe trauma patients. Fifty percents of patients underwent TNO. In
this group, bleeding control was achieved by angiographic embolization in 8 cases and by laparoscopy in 1. None of
these patients needed celiotomy. None of TNO patients died.
CONCLUSIONS: In a trauma referral center TNO of liver injury is possible in about 50%. TNO in severe trauma is
improved if a correct CT-scan evaluation at the admission is performed and angiography correctly applied. Laparoscopy
is an useful adjunctive tool in control of bleeding.

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