All medical records were carefully reviewed in this retrospective cohort study. We retrospectively evaluated patients who underwent initial treatment for liver trauma in the Department of Surgery at Fukuyama City Hospital between April 2010 and December 2019. To fill the gaps in knowledge, this study aimed to investigate the outcomes and management of BL and HAPs following severe blunt liver trauma. To our knowledge, few studies have examined the outcomes of HAPs after severe blunt liver injury. Although symptomatic pseudoaneurysms should be treated, the indications for treating asymptomatic pseudoaneurysms are controversial because the natural history of pseudoaneurysms is still unclear. Symptoms of HAPs vary from asymptomatic to signs of rupture with intraperitoneal hemorrhage. Previous studies have reported that the incidence of HAPs after blunt liver trauma is 1–5%. One of the other important complications after blunt liver trauma is hepatic artery pseudoaneurysm (HAP), which is rare but potentially fatal. Few studies have evaluated the management of BL according to the location of the injured bile duct. However, even if BL can be diagnosed during the initial operation, patients who have severe trauma are extremely unstable, which makes it difficult for surgeons to perform invasive surgery such as liver resection with reconstruction of the bile ducts.īlunt liver injury results in intra- and/or extrahepatic bile duct injury, and the clinical management of an injured bile duct is controversial due to the variety of bile duct injuries. Moreover, other aggressive treatments, such as partial liver resection, primary repair of the injured duct with T-tube insertion, and hepatectomy with hepaticojejunostomy, have also been reported to be successful in post-traumatic BL. Previous studies have reported that bile duct injury following blunt liver injury may be managed by percutaneous drainage and endoscopic stent treatment. Although the clinical diagnosis of BL is difficult, a delayed diagnosis leads to high morbidity and prolonged hospital stay, making early diagnosis crucial for patients. However, in patients with severe blunt liver injury of grade III or greater (based on the American Association for the Surgery of Trauma (AAST) liver injury scale ), who do not respond to initial fluid resuscitation, an emergency operation should be performed to control bleeding.įollowing blunt liver injury, bile leakage (BL), with an incidence rate that varies from 4 to 22%, is a major complication that leads to biloma and biliary fistula. Non-operative management is considered the first choice of treatment for hemodynamically stable patients with blunt liver injury. The liver is one of the most commonly injured organs in patients with blunt abdominal trauma. HAPs with grade III–V injury should be considered TAE. HAPs with grade I–II injury might disappear spontaneously. In contrast, the central bile duct injury requires surgical treatment. Severe blunt liver injury causing peripheral bile duct injury can be treated conservatively. Out of 10 patients with HAPs, only three with grade I–II injury and one with grade III–V were treated conservatively the rest six with grade III-V injury required transcatheter arterial embolization (TAE). Eight patients with grade III-V injury developed BL: surgical intervention was not needed for six patients with peripheral bile duct injury, but hepaticojejunostomy was needed for two patients with central bile duct injury. BL was not observed in patients with grade I–II injury. Patients were diagnosed with grade I–II liver injury (n = 127) and with grade III-V injury (n = 49). ResultsĪ total of 176 patients with blunt liver injury were evaluated. Patient characteristics and treatments were analyzed. We retrospectively evaluated patients diagnosed with blunt liver injury, graded by the American Association for the Surgery of Trauma Liver Injury Scale, who were admitted to our hospital between April 2010 and December 2019. The purpose of this study is to investigate the outcomes and management of post-traumatic BL and HAPs. The treatment of delayed complications after liver trauma such as bile leakage (BL) and hepatic artery pseudoaneurysms (HAPs) is difficult.
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