eMedicine Specialties > Radiology > Gastrointestinal

Liver, Trauma: Follow-up

Author: Ali Nawaz Khan, MBBS, FRCS, FRCP, FRCR, Consultant Radiologist and Honorary Professor, North Manchester General Hospital Pennine Acute NHS Trust, UK
Coauthor(s): Hemant Vadeyar, MBBS, Consulting Hepatobiliary and Pancreatic Surgeon, North Manchester General Hospital; Sumaira MacDonald, MBChB, PhD, MRCP, FRCR, Lecturer, Sheffield University Medical School; Endovascular Fellow, Sheffield Vascular Institute; Muthusamy Chandramohan, MBBS, DMRD, FRCR, Consultant Radiologist, Bradford Teaching Hospitals, UK
Contributor Information and Disclosures

Updated: Aug 25, 2009

Intervention

Blunt hepatic trauma more often causes venous injury and hemorrhage. Most arterial injuries are increasingly being caused by radiologic interventional procedures, such as liver biopsy, TIPS, PTC, and biliary drainage. The typical injury is a small pseudo-aneurysm, which may require meticulous, superselective angiography. A combined surgical and radiologic approach may be required in the treatment of patients with high-grade liver lacerations with injury to the retrohepatic inferior vena cava.25 Initially, the surgeon attempts to control the hemorrhage with temporary perihepatic packing.

Recurrent liver parenchymal bleeding can be successfully treated by using transcatheter embolization, and bleeding from a major hepatic vein can be controlled by placing an intravenous stent.26 Embolization can be performed in persistent arterial hemorrhage, as may occur with stab wounds of the liver, and in the occlusion of pseudo-aneurysms. Transcatheter arterial embolization may reduce transfusion requirements and allow healing of hepatic injuries without surgery.27

Because hepatic arteries are not end arteries, occlusive devices should be deployed distal to the lesion to prevent collateral backdoor filling. The entire hepatic artery may be occluded, if required, as long as the portal vein is patent. If the portal vein is occluded, only selective embolization can be performed; this should prevent liver infarction due the presence of intrahepatic collaterals. The uncommon complication of bile peritonitis can be confirmed by means of diagnostic aspiration under ultrasonographic or CT scan guidance.

Medicolegal Pitfalls

  • Nontarget embolization or backflow of particles from the target circulation to nontarget circulation is always a concern to the interventional radiologist, and this may be a particular problem when dealing with the heavily collateralized gastrointestinal circulation. Therefore, occlusive therapy for hepatic hemorrhage requires that the technique performed be meticulous, so that all collateral vessels are identified before embolization.
    • Superselective catheterization should be performed as far as possible.
    • With aneurysms or pseudo-aneurysms, the afferent and efferent vessels should be occluded to prevent retrograde filling of the aneurysms or pseudo-aneurysms.
    • Hepatic infarction or ischemia is not usually a problem in patients with a patent portal vein.

See also the Medscape topic Medical Malpractice and Legal Issues.


Special Concerns

  • Liver injury occurs more easily in children than in adults because children's ribs are more flexible, allowing force to be transmitted to the liver.
  • In addition, the liver is not fully developed in children, who have a weaker connective tissue framework than do adults.
 


More on Liver, Trauma

Overview: Liver, Trauma
Imaging: Liver, Trauma
Follow-up: Liver, Trauma
Multimedia: Liver, Trauma
References
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References

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Further Reading

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Keywords

liver trauma, liver injury, abdominal injury, abdominal trauma, blunt abdominal trauma, blunt abdominal injury, hepatic injury, blunt hepatic injury, hepatic trauma, central liver hematoma, subcapsular hematoma, intrahepatic hematoma, hepatic laceration, hepatic contusion, hepatic vascular disruption, bile duct injury, penetrating abdominal trauma, biliary disruption

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Contributor Information and Disclosures

Author

Ali Nawaz Khan, MBBS, FRCS, FRCP, FRCR, Consultant Radiologist and Honorary Professor, North Manchester General Hospital Pennine Acute NHS Trust, UK
Ali Nawaz Khan, MBBS, FRCS, FRCP, FRCR is a member of the following medical societies: American Association for the Advancement of Science, American Institute of Ultrasound in Medicine, British Medical Association, British Society of Interventional Radiology, Royal College of Physicians, Royal College of Physicians and Surgeons of the United States, Royal College of Radiologists, and Royal College of Surgeons of England
Disclosure: Nothing to disclose.

Coauthor(s)

Hemant Vadeyar, MBBS, Consulting Hepatobiliary and Pancreatic Surgeon, North Manchester General Hospital
Disclosure: Nothing to disclose.

Sumaira MacDonald, MBChB, PhD, MRCP, FRCR, Lecturer, Sheffield University Medical School; Endovascular Fellow, Sheffield Vascular Institute
Sumaira MacDonald, MBChB, PhD, MRCP, FRCR is a member of the following medical societies: British Medical Association, Royal College of Physicians, and Royal College of Radiologists
Disclosure: Nothing to disclose.

Muthusamy Chandramohan, MBBS, DMRD, FRCR, Consultant Radiologist, Bradford Teaching Hospitals, UK
Disclosure: Nothing to disclose.

Medical Editor

Neela Lamki, MD, Professor, Department of Radiology, Sultan Qaboos University, Oman; Adjunct Professor, Department of Radiology, Baylor College of Medicine
Disclosure: Nothing to disclose.

Pharmacy Editor

Bernard D Coombs, MB, ChB, PhD, Consulting Staff, Department of Specialist Rehabilitation Services, Hutt Valley District Health Board, New Zealand
Disclosure: Nothing to disclose.

Managing Editor

Spencer B Gay, MD, Professor of Radiology, Director of Body Computed Tomography, Department of Radiology, University of Virginia Health Sciences Center
Disclosure: Nothing to disclose.

CME Editor

Robert M Krasny, MD, Resolution Imaging Medical Corporation
Robert M Krasny, MD is a member of the following medical societies: American Roentgen Ray Society and Radiological Society of North America
Disclosure: Nothing to disclose.

Chief Editor

John Karani, MBBS, FRCR, Clinical Director of Radiology and Consultant Radiologist, Department of Radiology, King's College Hospital, London
John Karani, MBBS, FRCR is a member of the following medical societies: British Institute of Radiology, British Society of Interventional Radiology, Cardiovascular and Interventional Radiological Society of Europe, European Society of Gastrointestinal and Abdominal Radiology, European Society of Radiology, Radiological Society of North America, and Royal College of Radiologists
Disclosure: Nothing to disclose.

 
 
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