Impact of Cirrhosis on Outcomes in Trauma Dangleben, Dale A.; Jazaeri, Omid; Wasser, Thomas ...
Journal of the American College of Surgeons,
12/2006, Letnik:
203, Številka:
6
Journal Article
Recenzirano
Cirrhosis as an independent predictor of poor outcomes in trauma patients was identified in 1990. We hypothesized that the degree of preinjury hepatic dysfunction is, by itself, an independent ...predictor of mortality.
The trauma registry at our Level I trauma center was queried for all ICD-9 codes for liver disease from 1999 to 2003, and patients were categorized as having Child-Turcotte-Pugh (CTP) class A, B, or C cirrhosis. Data analyzed included age, mechanism of injury, Abbreviated Injury Score (AIS), Injury Severity Score (ISS), Glasgow Coma Score (GCS), hospital length of stay, ventilator days, procedures performed, transfusion of blood products, admission lactate, base deficit, and mortality. Trauma Related Injury Severity Score (TRISS) methodology was used to calculate the probability of survival. Outcomes data were analyzed, and statistical comparison was performed using group
t-test.
Of the 50 patients meeting study criteria, 31 had alcohol-related cirrhosis, 18 had a history of hepatitis C, and 1 had cryptogenic cirrhosis. Twenty (40%) met CTP A classification, 16 (32%) met CTP B criteria, and 14 (28%) had CTP class C cirrhosis. One death occurred in the CTP A and B groups. Comparison between the five survivors and nine nonsurvivors from CTP class C showed no statistical significance in terms of age, ISS, TRISS, or GCS.
The mortality rate for class C cirrhotic patients posttrauma continues to be higher than that predicted by TRISS, although patients with less severe hepatic dysfunction do not appear to have significantly lower than predicted survival. The degree of hepatic dysfunction remains an independent predictor of mortality and CTP C criteria must be considered when determining outcomes for patients posttrauma.
Upper extremity aneurysms are relatively infrequent when compared to other vessels in the body. However, a combination of factors occurring following arteriovenous fistula (AVF) ligation can lead to ...dilation of the brachial artery. Periodic follow-up after AVF creation can help prevent complications. We report a case of an immunosuppressed, patient with renal transplant who presented with delayed onset digital ischemia following ligation of a remotely created brachial artery-cephalic vein fistula.
Congenital anomalies of the inferior vena cava (IVC) are rare, but recognized, causing deep venous thrombosis. We present a case of a 50-year-old patient with trauma who suffered an intracranial ...hemorrhage secondary to a fall while on anticoagulation for deep vein thromboses. Venous return from the lower extremities was determined to be through dilated lumbar venous collaterals into the azygous and hemiazygous systems. A second interesting anatomic finding was a hypoplastic left kidney.
Traumatic injury to the extrahepatic biliary tract is rare, observed in approximately 3.5 per cent of patients requiring laparotomy for trauma.1 The majority of these injuries in adults are due to ...penetrating trauma,2 whereas in the pediatric population these injuries are secondary to blunt mechanisms.3 Obstructive jaundice caused by a bullet fragment within the common bile duct is extremely rare and has only been reported rarely in the literature. The mechanism seems to be migration of the bullet fragment from the initial site within the liver parenchyma to the common bile duct.4 The previous reports have demonstrated obstructive jaundice presenting in patients after trauma laparotomy who had required reoperation to relieve the obstruction either by primary repair of the common bile duct, hepaticojejunostomy, or choledocojejunostomy.
Missile embolism to the pulmonary artery is a rare event. We present a complicated case of missile embolism from the inferior vena cava to the pulmonary artery. The case illustrates the potential ...pitfalls in the management of these patients.
BACKGROUND:Hepatic angiography (HA) and hepatic angioembolization (HAE) are increasingly used to diagnose and treat intrahepatic arterial injuries. This study was performed to review indications, ...outcomes, and complications of HA/HAE in blunt trauma patients who underwent HAE as adjunct management of hepatic injury.
METHODS:A retrospective review of consecutive cases of HA/HAE at a Level I trauma center during an 8-year period. Data include demographics, physiologic condition, liver injury grade, HA/HAE indications, outcomes, morbidity, and mortality.
RESULTS:Seventy-nine patients underwent diagnostic HA; 31 (39%) had subsequent HAE. Fifty-eight hemodynamically stable patients had computerized axial tomographic (CT) scan followed by HA. HA was performed for contrast blush on CT in 30 (52%) of 58 patients, high-grade liver injury in 4 (7%), subsequent hemodynamic instability in 15 (27%), and angiography planned for other purpose in 9 (17%). HA confirmed arterial injury and led to HAE in 50% of patients with contrast blush on CT or high-grade liver injury. HA was negative when performed for hemodynamic instability or for other primary purposes. Twenty-one hemodynamically unstable patients underwent emergent laparotomy followed by postoperative HA with 11 (50%) requiring HAE. Overall mortality in HAE group was 16%, and liver-related morbidity was 29% usually presenting as gallbladder or liver necrosis.
CONCLUSION:HA/HAE should be used when CT scan suggests associated intrahepatic arterial or high-grade injury in the management of hepatic injuries and should also be considered after laparotomy and perihepatic packing to control inaccessible intrahepatic hemorrhage. Mortality related to HAE is uncommon, but morbidity occurs frequently.
Abstract
Isolated popliteal vein entrapment is a very rare occurrence. We present a case of a young man who developed isolated popliteal venous entrapment resulting from extrinsic compression by the ...popliteus muscle soon after initiating an exercise program.
BEZOARS CAUSING GASTROINTESTINAL obstruction IS a very rare occurrence, but has been well documented in the literature.1 In one study from China, bezoars were found in 46 of 496 patients with small ...bowel obstruction (SBO).2 Bezoars can be classified according to their origins as phytobezoar (undigested fruit or vegetable fibers), trichobezoar (hair), lactobezoar (undigested milk), pharmacobezoar (medications), or miscellaneous. CT scan findings include dilated intestinal loops with air-contrast levels and an intraluminal mass with gas bubbles retained in its interstices.4 This is clearly visualized in the preoperative abdominal CT scan of patient two (Fig. 3).
