EVALUATION, MODIFICATION, AND DECISION-MAKING IN DAMAGE CONTROL STRATEGY : HEPATIC INJURY MANAGED BY TAE, PHP, OAM, AND RESECTIONAL DEBRIDEMENT - A CASE REPORT
Treatment strategies for life-threatening liver injuries remain controversial and challenging. A man in his 50s, with a history of heavy drinking, suffered a blunt thoracoabdominal injury in a single motor vehicle crash. Transarterial embolization was performed for the posterior branch of the right...
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| Published in | Journal of the Japanese Association for the Surgery of Trauma Vol. 38; no. 3; pp. 435 - 440 |
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| Main Authors | , , , |
| Format | Journal Article |
| Language | Japanese |
| Published |
The Japanese Association for the Surgery of Trauma
20.07.2024
一般社団法人 日本外傷学会 |
| Subjects | |
| Online Access | Get full text |
| ISSN | 1340-6264 2188-0190 |
| DOI | 10.11382/jjast.38.3_02 |
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| Abstract | Treatment strategies for life-threatening liver injuries remain controversial and challenging. A man in his 50s, with a history of heavy drinking, suffered a blunt thoracoabdominal injury in a single motor vehicle crash. Transarterial embolization was performed for the posterior branch of the right hepatic artery because of an intraparenchymal hematoma with active arterial bleeding. After eight hours, perihepatic packing was conducted due to rebleeding. Six hours later, open abdomen management was administered for abdominal compartment syndrome. Forty hours later, a planned reoperation was performed, which included resectional debridement for liver injury and transcystic C-tube drainage. Drain management for liver infarction and infection was performed as a bridging treatment, and the patient was subsequently discharged in a favorable condition. It is suggested that continuous assessment and modification of the damage control strategy for severe liver injury helps achieve favorable outcomes. |
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| AbstractList | Treatment strategies for life-threatening liver injuries remain controversial and challenging. A man in his 50s, with a history of heavy drinking, suffered a blunt thoracoabdominal injury in a single motor vehicle crash. Transarterial embolization was performed for the posterior branch of the right hepatic artery because of an intraparenchymal hematoma with active arterial bleeding. After eight hours, perihepatic packing was conducted due to rebleeding. Six hours later, open abdomen management was administered for abdominal compartment syndrome. Forty hours later, a planned reoperation was performed, which included resectional debridement for liver injury and transcystic C-tube drainage. Drain management for liver infarction and infection was performed as a bridging treatment, and the patient was subsequently discharged in a favorable condition. It is suggested that continuous assessment and modification of the damage control strategy for severe liver injury helps achieve favorable outcomes. Treatment strategies for life-threatening liver injuries remain controversial and challenging. A man in his 50s, with a history of heavy drinking, suffered a blunt thoracoabdominal injury in a single motor vehicle crash. Transarterial embolization was performed for the posterior branch of the right hepatic artery because of an intraparenchymal hematoma with active arterial bleeding. After eight hours, perihepatic packing was conducted due to rebleeding. Six hours later, open abdomen management was administered for abdominal compartment syndrome. Forty hours later, a planned reoperation was performed, which included resectional debridement for liver injury and transcystic C-tube drainage. Drain management for liver infarction and infection was performed as a bridging treatment, and the patient was subsequently discharged in a favorable condition. It is suggested that continuous assessment and modification of the damage control strategy for severe liver injury helps achieve favorable outcomes. 生命を脅かす肝損傷に対する治療戦略は依然として議論と課題がある. 50歳代の男性, 大酒家で, 乗用車単独事故で胸腹部鈍的外傷を来した. 後区域の複雑深在性肝損傷で後区域枝をtranscatheter arterial embolizationした. 8時間後に再出血をみてperihepatic packingを行った. 6時間後に腹部コンパートメントでopen abdomen managementを行った. 40時間後に計画的再手術として肝損傷に対するresectional debridementと経胆嚢管的ドレナージを行った. 術後の肝梗塞と感染に対してドレーン管理を行い軽快退院した. 重症肝損傷に対して継続的かつ詳細な評価と修正を行い, 適切な加療を随時行うダメージコントロール戦略が良好な予後をもたらしうる. |
| Author | TOMIOKA, Joji KURATA, Hideaki OKAMURA, Shoko TOKUMARU, Teppei |
| Author_FL | TOKUMARU Teppei KURATA Hideaki 冨岡 譲二 岡村 祥子 |
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| DocumentTitleAlternate | ダメージコントロール戦略における評価, 修正そして決断 : TAE, PHP, OAMそしてresectional debridementとつないで救命した重症肝損傷の1例 |
| DocumentTitle_FL | ダメージコントロール戦略における評価, 修正そして決断 : TAE, PHP, OAMそしてresectional debridementとつないで救命した重症肝損傷の1例 |
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| PublicationTitle | Journal of the Japanese Association for the Surgery of Trauma |
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| PublicationTitle_FL | 日本外傷学会雑誌 日外傷会誌 J. Jpn. Assoc. Surg. Trauma |
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| Publisher | The Japanese Association for the Surgery of Trauma 一般社団法人 日本外傷学会 |
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| References | 2) Kang BH, Jung K, Choi D, et al : Early re-laparotomy for patients with high-grade liver injury after damage-control surgery and perihepatic packing. Surg Today 2021 ; 51 : 891-896. 8) Rouy M, Julien C, Hamouda I, et al : Predictive factors of non-operative management failure in 494 blunt liver injuries : a multicenter retrospective study. Updates Surg 2022 ; 74 : 1901-1913. 6) Miyayama S, Yamakado K, Anai H, et al : Guidelines on the use of gelatin sponge particles in embolotherapy. Jpn J Radiol 2014 ; 32 : 242-250. 16) Granieri S, Bracchetti G, Kersik A, et al : Preoperative indocyanine green (ICG) clearance test : Can we really trust it to predict post hepatectomy liver failure? A systematic review of the literature and meta-analysis of diagnostic test accuracy. Photodiagnosis Photodyn Ther 2022 ; 40 : 103170. 12) Letoublon C, Amariutei A, Taton N, et al : Management of blunt hepatic trauma. J Visc Surg 2016 ; 153 : 33-43. 1) Feliciano DV : Abdominal Trauma Revisited. Am Surg 2017 ; 83 : 1193-1202. 3) Lin BC, Fang JF, Chen RJ, 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 : 122-127. 17) 比良英司, 渡部広明 : これからの重症体幹部外傷の治療戦略はどうあるべきか? DCSとDCIRのコラボレーション体制の構築. 日外傷会誌 2022 ; 36 : 39-46. 9) Campana L, Esser H, Huch M, et al : Liver regeneration and inflammation : from fundamental science to clinical applications. Nat Rev Mol Cell Biol 2021 ; 22 : 608-624. 4) Coccolini F, Coimbra R, Ordonez C, et al : WSES expert panel. Liver trauma : WSES 2020 guidelines. World J Emerg Surg 2020 ; 15 : 24. 15) Sumiyoshi T, Okabayashi T, Negoro Y, et al : 99mTc-GSA SPECT/CT fusion imaging for hepatectomy candidates with extremely deteriorated ICG value. Jpn J Radiol 2018 ; 36 : 537-543. 14) Sumiyoshi T, Shima Y, Okabayashi T, et al : Functional discrepancy between two liver lobes after hemilobe biliary drainage in patients with jaundice and bile duct cancer : an appraisal using (99m) Tc-GSA SPECT/CT fusion imaging. Radiology 2014 ; 273 : 444-451. 10) Lin BC, Fang JF, Chen RJ, 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 : 122-127. 11) Kushimoto S, Miyauchi M, Yokota H, et al : Damage control surgery and open abdominal management : recent advances and our approach. J Nippon Med Sch 2009 ; 76 : 280-290. 13) Badger SA, Barclay R, Campbell P, et al : Management of liver trauma. World J Surg 2009 ; 33 : 2522-2537. 5) Kim M, Cho H : Damage control strategy in bleeding trauma patients. Acute Crit Care 2020 ; 35 : 237-241. 7) 船曵知弘, 折田智彦, 佐藤智洋, ほか : 鈍的肝損傷に対するCT所見から見た経カテーテル的動脈塞栓術の適応と限界. 日腹部救急医会誌 2016 ; 36 : 1053-1059. |
| References_xml | – reference: 1) Feliciano DV : Abdominal Trauma Revisited. Am Surg 2017 ; 83 : 1193-1202. – reference: 5) Kim M, Cho H : Damage control strategy in bleeding trauma patients. Acute Crit Care 2020 ; 35 : 237-241. – reference: 17) 比良英司, 渡部広明 : これからの重症体幹部外傷の治療戦略はどうあるべきか? DCSとDCIRのコラボレーション体制の構築. 日外傷会誌 2022 ; 36 : 39-46. – reference: 12) Letoublon C, Amariutei A, Taton N, et al : Management of blunt hepatic trauma. J Visc Surg 2016 ; 153 : 33-43. – reference: 15) Sumiyoshi T, Okabayashi T, Negoro Y, et al : 99mTc-GSA SPECT/CT fusion imaging for hepatectomy candidates with extremely deteriorated ICG value. Jpn J Radiol 2018 ; 36 : 537-543. – reference: 13) Badger SA, Barclay R, Campbell P, et al : Management of liver trauma. World J Surg 2009 ; 33 : 2522-2537. – reference: 9) Campana L, Esser H, Huch M, et al : Liver regeneration and inflammation : from fundamental science to clinical applications. Nat Rev Mol Cell Biol 2021 ; 22 : 608-624. – reference: 6) Miyayama S, Yamakado K, Anai H, et al : Guidelines on the use of gelatin sponge particles in embolotherapy. Jpn J Radiol 2014 ; 32 : 242-250. – reference: 16) Granieri S, Bracchetti G, Kersik A, et al : Preoperative indocyanine green (ICG) clearance test : Can we really trust it to predict post hepatectomy liver failure? A systematic review of the literature and meta-analysis of diagnostic test accuracy. Photodiagnosis Photodyn Ther 2022 ; 40 : 103170. – reference: 10) Lin BC, Fang JF, Chen RJ, 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 : 122-127. – reference: 3) Lin BC, Fang JF, Chen RJ, 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 : 122-127. – reference: 7) 船曵知弘, 折田智彦, 佐藤智洋, ほか : 鈍的肝損傷に対するCT所見から見た経カテーテル的動脈塞栓術の適応と限界. 日腹部救急医会誌 2016 ; 36 : 1053-1059. – reference: 14) Sumiyoshi T, Shima Y, Okabayashi T, et al : Functional discrepancy between two liver lobes after hemilobe biliary drainage in patients with jaundice and bile duct cancer : an appraisal using (99m) Tc-GSA SPECT/CT fusion imaging. Radiology 2014 ; 273 : 444-451. – reference: 8) Rouy M, Julien C, Hamouda I, et al : Predictive factors of non-operative management failure in 494 blunt liver injuries : a multicenter retrospective study. Updates Surg 2022 ; 74 : 1901-1913. – reference: 2) Kang BH, Jung K, Choi D, et al : Early re-laparotomy for patients with high-grade liver injury after damage-control surgery and perihepatic packing. Surg Today 2021 ; 51 : 891-896. – reference: 11) Kushimoto S, Miyauchi M, Yokota H, et al : Damage control surgery and open abdominal management : recent advances and our approach. J Nippon Med Sch 2009 ; 76 : 280-290. – reference: 4) Coccolini F, Coimbra R, Ordonez C, et al : WSES expert panel. Liver trauma : WSES 2020 guidelines. World J Emerg Surg 2020 ; 15 : 24. |
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| SubjectTerms | damage control surgery liver injury resectional debridement ダメージコントロール手術 リゼクショナルデブリードマン 肝損傷 |
| Title | EVALUATION, MODIFICATION, AND DECISION-MAKING IN DAMAGE CONTROL STRATEGY : HEPATIC INJURY MANAGED BY TAE, PHP, OAM, AND RESECTIONAL DEBRIDEMENT - A CASE REPORT |
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