Management of Hepatic Trauma
Summarized by: Sakib Kazi, M.D.
Reviewed by: Prasaanthan Gopee-Ramanan, M.D.
Original publication details
Authors: Shenise Gilyard, Kaitlin Shinn, Nariman Nezami, Laura K. Findeiss, Sean Dariushnia, April A. Grant, C. Matthew Hawkins, Gail L. Peters, Bill S. Majdalany, Janice Newsome, Zachary L. Bercu, Nima Kokabi
DOI: https://doi.org/10.1055/s-0039-3401838
Reference: Gilyard, S., Shinn, K., Nezami, N., Findeiss, L. K., Dariushnia, S., Grant, A. A., Hawkins, C. M., Peters, G. L., Majdalany, B. S., Newsome, J., Bercu, Z. L., & Kokabi, N. (2020). Contemporary management of hepatic trauma: What irs need to know. Seminars in Interventional Radiology, 37(01), 035–043.
Adult management
If hemodynamically stable → multiphase CT for pseudoaneurysm or active extravasation.
If pseudoaneurysm or active extravasation present → angioembolization (Else → managed non operatively).
If hemodynamically unstable → open surgery or open surgery + embolization.
Pediatric management
If hemodynamically stable → non operatively.
If failure with fluid resuscitation and recurrent hypotension → surgery.
No established indications for angiography or embolization in this population.
Effective embolization
Multiphase CT is the preferred diagnostic modality to assess liver trauma and hemorrhage. Due to high risk of infection, ensure appropriate antibiotic peri-operatively for hepatic arterial embolization.
Femoral approach for arterial access is the mainstay of treatment.
Assess for active extravasation, pseudoaneurysm, arteriovenous shunting, and venous bleeding on angiography.
Embolic agents should be selected according to findings on CT or angiography.
Follow-up imaging post embolization
No aggressive imaging follow-up in asymptomatic cases.
If new symptoms → multiphase CT.
Post embolization complications to assess for on imaging include bile leak, intrahepatic biloma, hepatic necrosis, and hepatic abscess.
Citation
Gilyard, S., Shinn, K., Nezami, N., Findeiss, L. K., Dariushnia, S., Grant, A. A., Hawkins, C. M., Peters, G. L., Majdalany, B. S., Newsome, J., Bercu, Z. L., & Kokabi, N. (2020). Contemporary management of hepatic trauma: What irs need to know. Seminars in Interventional Radiology, 37(01), 035–043. https://doi.org/10.1055/s-0039-3401838