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Delayed Celiotomy or Laparoscopy as part of the Nonoperative Management of Blunt Hepatic Trauma

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Abstract

Background

Nonoperative management (NOM) is considered standard treatment for 80% of blunt hepatic trauma (BHT). NOM is associated with some events that may require delayed operation (DO), usually considered a criterion of failure of NOM.

Methods

A retrospective case note review was performed on 257 consecutive patients with BHT, with a median age of 32.7 years, admitted from 1994 to 2005. We considered the 186 patients (72%) who had an initial indication of NOM, and focused on the 28 patients who were secondarily operated (DO), mainly on the 22 patients operated on for liver-related indications. Celioscopy was used in five cases.

Results

The severity grade of these 22 patients was: zero grade I, seven grade II, ten grade III, four grade IV, one grade V. The timing of DO varied from day 0 to day 11. Ten patients were operated on for a peritoneal inflammatory syndrome. Death occurred in three patients at days 2, 10, and 125. One was attributed to underestimation of hepatic necrosis, another to a nondiagnosed peritoneal inflammatory syndrome; 27, 3% of the patients had liver-related complications.

Conclusions

Our data suggest that BHT treated by NOM must be frequently reevaluated and that DO is an actual part of the so-called nonoperative treatment. The use of laparoscopic washing has to be proposed as soon as day 3 or 5 in patients with large hemoperitoneum and any sign of inflammatory response (fever, leukocytosis, discomfort, tachycardia).

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Authors and Affiliations

  1. Departement de chirurgie digestive et de l’urgence, Hopital Michallon, BP 217, 38043, Grenoble, cedex, France

    Christian Letoublon, Yao Chen, Catherine Arvieux, David Voirin, Irene Morra, Christophe Broux & Olivier Risse

Authors
  1. Christian Letoublon
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  2. Yao Chen
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  3. Catherine Arvieux
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  4. David Voirin
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  5. Irene Morra
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  6. Christophe Broux
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  7. Olivier Risse
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Correspondence to Christian Letoublon.

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Letoublon, C., Chen, Y., Arvieux, C. et al. Delayed Celiotomy or Laparoscopy as part of the Nonoperative Management of Blunt Hepatic Trauma. World J Surg 32, 1189–1193 (2008). https://doi.org/10.1007/s00268-007-9439-y

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  • DOI: https://doi.org/10.1007/s00268-007-9439-y

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