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IR Playbook pp 357-369 | Cite as

Visceral and Solid Organ Trauma

  • Kari J. Nelson
  • Mitchell Daun
Chapter

Abstract

Care for the trauma patient requires a multidisciplinary approach with collaborative involvement between the emergency department, trauma service, interventional radiology (IR), and numerous other surgical subspecialties. IR has an established and integrated role in the non-operative management of trauma patients. Injuries related to abdominal trauma span a wide range of severity with a variety of clinical presentations and radiologic findings. Though traumatic injury to the solid organs of the abdomen historically necessitated surgical management, a significant shift to non-operative strategies has occurred over the past several decades. Non-operative management (NOM) aims for preservation of the affected organ while avoiding morbidity related to major surgery. Transarterial embolization (TAE) for injury to the spleen, liver, and kidney has become an important part of non-operative management in hemodynamically stable patients, achieving hemostasis while preserving viable tissue within the injured organ. Via specific and selective intervention, TAE has also emerged as an important adjunct for management of ongoing hemorrhage in postoperative trauma patients.

Keywords

Liver trauma Splenic trauma Kidney trauma Laceration Avulsion Shattered organ Trauma embolization Nontarget pancreatic embolization 

References

  1. 1.
    Miller P, Chang M, Hoth J, Mowery N, Hildreth A, Martin R, et al. Prospective trial of angiography and embolization for all grade III to V blunt splenic injuries: nonoperative management success rate is significantly improved. J Am Coll Surg. 2014;218(4):644–8.CrossRefPubMedGoogle Scholar
  2. 2.
    Olthof D, van der Vlies C, Joosse P, van Delden O, Jurkovich G, Goslings J. Consensus strategies for the nonoperative management of patients with blunt splenic injury. J Trauma Acute Care Surg. 2013;74(6):1567–74.CrossRefPubMedGoogle Scholar
  3. 3.
    Cales R, Trunkey D. Preventable trauma deaths. A review of trauma care systems development. JAMA. 1985;254(8):1059–63.CrossRefPubMedGoogle Scholar
  4. 4.
    Soto J, Anderson S. Multidetector CT of blunt abdominal trauma. Radiology. 2012;265(3):678–93.CrossRefPubMedGoogle Scholar
  5. 5.
    Moore EE, Cogbill TH, Jurkovich GJ, Shackford SR, Malangoni MA, Champion HR. Organ injury scaling: spleen and liver (1994 revision). J Trauma Acute Care Surg. 1995;38(3):323–4.CrossRefGoogle Scholar
  6. 6.
    Hagiwara A, Fukushima H, Murata A, Matsuda H, Shimazaki S. Blunt splenic injury: usefulness of transcatheter arterial embolization in patients with a transient response to fluid resuscitation 1. Radiology. 2005;235(1):57–64.CrossRefPubMedGoogle Scholar
  7. 7.
    Beuran M, Gheju I, Venter MD, Marian RC, Smarandache R. Non-operative management of splenic trauma. J Med Life. 2012;5(1):47.PubMedPubMedCentralGoogle Scholar
  8. 8.
    Uranüs S, Pfeifer J. Nonoperative treatment of blunt splenic injury. World J Surg. 2001;25(11):1405–7.CrossRefPubMedGoogle Scholar
  9. 9.
    Schroeppel TJ, Croce MA. Diagnosis and management of blunt abdominal solid organ injury. Curr Opin Crit Care. 2007;13(4):399–404.CrossRefPubMedGoogle Scholar
  10. 10.
    Schnüriger B, Inaba K, Konstantinidis A, Lustenberger T, Chan LS, Demetriades D. Outcomes of proximal versus distal splenic artery embolization after trauma: a systematic review and meta-analysis. J Trauma. 2011;70(1):252–60.CrossRefPubMedGoogle Scholar
  11. 11.
    Ekeh AP, Khalaf S, Ilyas S, Kauffman S, Walusimbi M, McCarthy MC. Complications arising from splenic artery embolization: a review of an 11-year experience. Am J Surg. 2013;205(3):250–4.CrossRefPubMedGoogle Scholar
  12. 12.
    Frandon J, Rodière M, Arvieux C, Michoud M, Vendrell A, Broux C, et al. Blunt splenic injury: outcomes of proximal versus distal and combined splenic artery embolization. Diagn Interv Imaging. 2014;95(9):825–31.CrossRefPubMedGoogle Scholar
  13. 13.
    McIntyre LK, Schiff M, Jurkovich GJ. Failure of nonoperative management of splenic injuries: causes and consequences. Arch Surg. 2005;140(6):563–9.CrossRefPubMedGoogle Scholar
  14. 14.
    Leeper WR, Leeper TJ, Ouellette D, Moffat B, Sivakumaran T, Charyk-Stewart T, et al. Delayed hemorrhagic complications in the nonoperative management of blunt splenic trauma: early screening leads to a decrease in failure rate. J Trauma Acute Care Surg. 2014;76(6):1349–53.CrossRefPubMedGoogle Scholar
  15. 15.
    Jahromi AH, Migliaro M, Romano M, Sangster G. Delayed splenic rupture; normal appearing spleen on the initial multidetector computed tomography (MDCT) can sometimes be misleading. Trauma Mon. 2016;21(5):e24465.Google Scholar
  16. 16.
    Wahl WL, Ahrns KS, Chen S, Hemmila MR, Rowe SA, Arbabi S. Blunt splenic injury: operation versus angiographic embolization. Surgery. 2004;136(4):891–9.CrossRefPubMedPubMedCentralGoogle Scholar
  17. 17.
    Dake M, Geschwind J, editors. Abrams’ angiography: interventional radiology. 3rd ed. Philadelphia: Lippincott Williams & Wilkins; 2014.Google Scholar
  18. 18.
    Hiatt JR, Gabbay J, Busuttil RW. Surgical anatomy of the hepatic arteries in 1000 cases. Ann Surg. 1994;220(1):50.CrossRefPubMedPubMedCentralGoogle Scholar
  19. 19.
    Stassen NA, Bhullar I, Cheng JD, Crandall M, Friese R, Guillamondegui O, et al. Nonoperative management of blunt hepatic injury: an Eastern Association for the Surgery of Trauma practice management guideline. J Trauma Acute Care Surg. 2012;73(5):S288–93.CrossRefPubMedGoogle Scholar
  20. 20.
    Arvieux C, Letoublon C. Abbreviated laparotomy. J Chirurg. 2000;137(3):133–41.PubMedGoogle Scholar
  21. 21.
    Tinkoff G, Esposito TJ, Reed J, Kilgo P, Fildes J, Pasquale M, Meredith JW. American Association for the Surgery of Trauma Organ Injury Scale I: spleen, liver, and kidney, validation based on the National Trauma Data Bank. J Am Coll Surg. 2008;207(5):646–55.CrossRefPubMedGoogle Scholar
  22. 22.
    Green CS, Bulger EM, Kwan SW. Outcomes and complications of angioembolization for hepatic trauma: a systematic review of the literature. J Trauma Acute Care Surg. 2016;80(3):529–37.CrossRefPubMedPubMedCentralGoogle Scholar
  23. 23.
    Melloul E, Denys A, Demartines N. Management of severe blunt hepatic injury in the era of computed tomography and transarterial embolization: a systematic review and critical appraisal of the literature. J Trauma Acute Care Surg. 2015;79(3):468–74.CrossRefPubMedGoogle Scholar
  24. 24.
    Kozar RA, Moore FA, Cothren CC, Moore EE, Sena M, Bulger EM, et al. Risk factors for hepatic morbidity following nonoperative management: multicenter study. Arch Surg. 2006;141(5):451–9.CrossRefPubMedGoogle Scholar
  25. 25.
    Venkatesan AM, Kundu S, Sacks D, Wallace MJ, Wojak JC, Rose SC, et al. Practice guideline for adult antibiotic prophylaxis during vascular and interventional radiology procedures. J Vasc Interv Radiol. 2010;21(11):1611–30.CrossRefPubMedGoogle Scholar
  26. 26.
    Richardson JD, Franklin GA, Lukan JK, Carrillo EH, Spain DA, Miller FB, et al. Evolution in the management of hepatic trauma: a 25-year perspective. Ann Surg. 2000;232(3):324–30.CrossRefGoogle Scholar
  27. 27.
    Maarouf AM, Ahmed AF, Shalaby E, Badran Y, Salem E, Zaiton F. Factors predicting the outcome of non-operative management of high-grade blunt renal trauma. Afr J Urol. 2015;21(1):44–51.CrossRefGoogle Scholar
  28. 28.
    Moore EE, Shackford SR, Pachter HL, McAninch JW, Browner BD, Champion HR, et al. Organ injury scaling: spleen, liver, and kidney. J Trauma Acute Care Surg. 1989;29(12):1664–6.CrossRefGoogle Scholar
  29. 29.
    Lanchon C, Fiard G, Arnoux V, Descotes JL, Rambeaud JJ, Terrier N, et al. High grade blunt renal trauma: predictors of surgery and long-term outcomes of conservative management. A prospective single center study. J Urol. 2016;195(1):106–11.CrossRefPubMedGoogle Scholar
  30. 30.
    Miller KS, McAninch JW. Radiographic assessment of renal trauma: our 15-year experience. J Urol. 1995;154(2):352–5.CrossRefPubMedGoogle Scholar
  31. 31.
    Vozianov S, Sabadash M, Shulyak A. Experience of renal artery embolization in patients with blunt kidney trauma. Cen Eur J Urol. 2015;68(4):471–7.Google Scholar
  32. 32.
    Dinkel HP, Danuser H, Triller J. Blunt renal trauma: minimally invasive management with microcatheter embolization—experience in nine patients 1. Radiology. 2002;223(3):723–30.CrossRefPubMedGoogle Scholar
  33. 33.
    Beyer C, Zakaluzny S, Humphries M, Shatz D. Multidisciplinary management of blunt renal artery injury with endovascular therapy in the setting of polytrauma: a case report and review of the literature. Ann Vasc Surg. 2017;38:318–e11.CrossRefPubMedGoogle Scholar

Copyright information

© Springer International Publishing AG, part of Springer Nature 2018

Authors and Affiliations

  1. 1.Department of Radiological SciencesVascular and Interventional Radiology, University of California, Irvine Medical CenterOrangeUSA
  2. 2.Department of RadiologyUniversity of California, Irvine Medical CenterOrangeUSA

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