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Hepatic
Hepatic
Hepatic
1- Radiology Department
2- Digestive Surgery Department
3- Anesthesia Department
• Prevalence = 1% to 8%
• Mortality rate = 4.1% to 11.7%
•
NOM
• NOM=Nonoperative management
• Level 1
– Patients who are hemodynamically unstable or who have diffuse
peritonitis after blunt abdominal trauma should be taken
urgently for laparotomy
• Liver Lesions
– Subcaps hematoma
– Intraparenchymal Hematoma
– Intraparenchymal laceration
– Active extravasation
– False aneurysm
Intraparenchymal hematoma
Active extravasation
Embolization principles
• Coeliac trunk must be analyse before
embolization
• Embolic material:
– Temporary or definitive
Results
• NOM
– Success rates ranging from 82% to 100%. (US trauma centers)
– Complications including bile leaks, hemobilia, bile peritonitis,
bilious ascites, hemoperitoneum, abdominal compartment
syndrome, missed injuries, hepatic necrosis, hepatic abscess,
and delayed hemorrhage.
– The complication rate increases with the grade of injury
• Embolization
– success rate is 95% 1
– Hepatic necrosis is rare
– First complication is gallbladder necrosis
• Liver Embolization
– Propose when active hemorrhage in CT scan
– Good success rate