Changing patterns in diagnostic strategies and the treatment of blunt injury to solid abdominal organs

Background: In recent years there has been increasing interest shown in the nonoperative management (NOM) of blunt traumatic injury. The growing use of NOM for blunt abdominal organ injury has been made possible because of the progress made in the quality and availability of the multidetector computed tomography (MDCT) scan and the development of minimally invasive intervention options such as angioembolization. Aim: The purpose of this review is to describe the changes that have been made over the past decades in the management of blunt trauma to the liver, spleen and kidney. Results: The management of blunt abdominal injury has changed considerably. Focused assessment with sonography for trauma (FAST) examination has replaced diagnostic peritoneal lavage as diagnostic modality in the primary survey. MDCT scanning with intravenous contrast is now the gold standard diagnostic modality in hemodynamically stable patients with intra-abdominal fluid detected with FAST. One of the current discussions in the l erature is whether a whole body MDCT survey should be implemented in the primary survey. Conclusions The progress in imaging techniques has contributed to NOM being currently the treatment of choice for hemodynamically stable patients. Angioembolization can be used as an adjunct to NOM and has increased the succe

Pyogenic liver abscess after gunshot injury: 10 years’ experience at a single level 1 trauma center

Liver abscesses are approximately 50 % of all visceral abscesses, and trauma presents as a rare cause of the liver abscess. Otherwise, hepatic abscess is an uncommon complication of gunshot wound (GSW) to the liver among all trauma cases. Here we reviewed their experience in detail. From January 1, 2004 to September 30, 2013, there were 2143 patients admitted to Ryder Trauma Center at Jackson Memorial Hospital/University of Miami with severe abdominal trauma: 1227 penetrating and 866 blunt. Among the patients who had penetrating trauma, 637 had GSWs and 551 had stab wounds. Thirty-nine patients had other kinds of penetrating traumas. Eleven patients were identified as having liver abscess, with 8 of them belonging to the GSW group, and 3 to the blunt injury group. The diagnosis and management of the 8 patients with a hepatic abscess after GSW to the liver were demonstrated. There were seven males and one female with a mean age of 29 ± 10 years. There were one grade 2, four grade 3, two grade 4 and one grade 5 injuries. The mean abscess size was 10 ± 2 cm. The abscesses were usually caused by infection from mixed organisms. These abscesses were treated with antibiotics and drainage. No mortality and long-term morbidity were seen. Hepatic abscess after GSW to the liver is a rare condition, with an incidence of 1.2 %. It is usually seen in severe liver injury (grade 3 and above), but our patients were all treated successfully, with no mortality