[The diagnostic-therapeutic picture in liver injuries: a review of the literature and clinical cases].
Approximately 80% of liver trauma cases have a good prognosis and do not create decision-making problems for the surgeon, while in the remaining 20% the correct choice still represents a problem. Recently there has been a trend toward more conservative surgical management with emphasis on hemostasis and debridement, as well as a move toward a non-surgical alternative (surgical abstention) where feasible, relying in such cases on first-line CT scans for trauma evaluation. We report 51 cases of liver trauma observed in the period 1985-1993 graded according to the AAST Liver Injury Scale as follows: 12 grade I lesions (23.5%), 7 grade II lesions (13.7%), 19 grade III lesions (37.3%), 7 grade IV lesions (13.7%), and 6 grade V lesions (11.8%). In managing these cases we relied on two first-line diagnostic procedures: diagnostic peritoneal lavage (DPL) and CT scans. DPL, performed on 10 blunt trauma victims with unstable vital signs, was positive in 7 who thus underwent immediate surgery, and negative in 3 who subsequently underwent CT scan. Another 14 blunt trauma victims with stable vital signs underwent first-line CT scanning. In the event of a CT grade III or IV lesion patients underwent surgery, while patients with a CT grade I or II lesion were followed expectantly. Deaths (14) occurred only among patients with grade III or IV lesions (including 9 multiple trauma victims) who underwent surgery.
Terrinoni
V
V
Istituto di I Clinica Chirurgica, Università degli Studi La Sapienza, Roma.
Catroppo
J F
JF
Caramanico
L
L
Cosimati
A
A
Cosimati
P
P
Bellini
N
N
Abate
O
O
Rengo
M
M
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D004630:Emergencies; D005260:Female; D006498:Hepatectomy; D006801:Humans; D008099:Liver / Q000293:injuries* / Q000601:surgery; D008297:Male; D008875:Middle Aged; D015599:Trauma Severity Indices; D014949:Wounds, Nonpenetrating / Q000145:classification / Q000175:diagnosis* / Q000601:surgery; D014950:Wounds, Penetrating / Q000145:classification / Q000175:diagnosis* / Q000601:surgery
Inquadramento diagnostico-terapeutico nei traumi epatici: revisione della letteratura e casistica clinica.