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World Journal of Surgery

, Volume 39, Issue 5, pp 1312–1319 | Cite as

Adrenal Gland Trauma: Is Extravasation an Absolute Indication for Intervention?

  • Chien-Hung Liao
  • Kuo-Jen Lin
  • Chih-Yuan Fu
  • Shang-Yu Wang
  • Shang-Ju Yang
  • Chun-Hsiang Ouyang
Original Scientific Report

Abstract

Background

Adrenal gland trauma (AGT) is potentially devastating if unrecognized during the treatment of trauma patients. Because of the adrenal glands’ rich vascularity, they often hemorrhage upon traumatic impact. However, there has been no conclusion about the indications for intervention in cases of hemorrhage after AGT.

Methods

We conducted a prospective collection with a retrospective review in a Level I trauma center in Taiwan. This study enrolled all of the patients who suffered from AGT from May 2008 to May 2013. We retrieved and analyzed the patient demographic data, clinical presentation, AGT grade, injury severity score, management, hospital stay, and mortality.

Results

The cohort consisted of 60 patients. The mean age was 31.0 ± 15.9 years. There were 32 patients (53.3 %) with extravasated AGT, which was associated with a high injury severity score, a high possibility of associated lung injury, and more than one accompanying trauma. Most of the patients could be treated conservatively. Five of these patients needed surgical hemostasis, and four of them needed angiographic embolization. Extravasation combined with a mean arterial pressure <70 mmHg was a predictor of the need for intervention (relative risk: 9.52, 95 % CI 1.64–55.56, p = 0.011).

Conclusion

In conclusion, AGT is a rare injury with a good prognosis. Most AGT patients can be treated conservatively. Extravasation in AGT is not only a sign of hemorrhage, but also an indicator of severe associated injuries. However, extravasation in AGT does not always require further treatment. When intractable hypotension simultaneously occurs, further treatment should be considered.

Keywords

Adrenal Gland Mean Arterial Pressure Injury Severity Score Chang Gung Memorial Hospital Revise Trauma Score 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

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Copyright information

© Société Internationale de Chirurgie 2015

Authors and Affiliations

  • Chien-Hung Liao
    • 1
  • Kuo-Jen Lin
    • 2
  • Chih-Yuan Fu
    • 1
  • Shang-Yu Wang
    • 1
  • Shang-Ju Yang
    • 1
  • Chun-Hsiang Ouyang
    • 1
  1. 1.Department of Trauma and Emergency SurgeryChang Gung Memorial Hospital, Chang Gung UniversityTaoyuanTaiwan
  2. 2.Department of UrologyChang Gung Memorial Hospital, Chang Gung UniversityTaoyuanTaiwan

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