ABSTRACT
For the last 20 years, nonoperative management (NOM) of blunt hepatic trauma (BHT) has been the initial policy whenever this is possible (80% of cases), i.e., in all cases where the hemodynamic status does not demand emergency laparotomy. NOM relies upon the coexistence of three highly effective treatment modalities: radiology with contrast-enhanced computerized tomography (CT) and hepatic arterial embolization, intensive care surveillance, and finally delayed surgery (DS). DS is not a failure of NOM management but rather an integral part of the surgical strategy. When imposed by hemodynamic instability, the immediate surgical option has seen its effectiveness transformed by development of the concept of abbreviated (damage control) laparotomy and wide application of the method of perihepatic packing (PHP). The effectiveness of these two conservative and cautious strategies for initial management is evidenced by current experience, but the management of secondary events that may arise with the most severe grades of injury must be both rapid and effective.
Subject(s)
Liver/injuries , Wounds, Nonpenetrating/therapy , Embolization, Therapeutic , Hemorrhage/therapy , Humans , Intra-Abdominal Hypertension , Liver Diseases/therapy , Peritoneal Diseases/therapy , Postoperative Care , Reoperation , Tomography, X-Ray Computed , Wounds, Nonpenetrating/complications , Wounds, Nonpenetrating/surgeryABSTRACT
Accessory liver lobes are a rare condition and appear to be due to excessive development of the liver. The presence of an accessory hepatic lobe is often diagnosed incidentally and sometimes revealed if it develops torsion, especially in pedunculated forms. In most cases, the accessory lobe is located below the liver, i.e., infrahepatic. Riedel's lobe is the best-known example of an accessory lobe, corresponding to hypertrophy of segments V and VI. While accessories lobes can simulate tumors, there have also been reports of hepatocellular tumor(s) that developed in these accessory lobes. Based on a review of the literature, this update focuses on accessory hepatic lobes.
Subject(s)
Hepatomegaly/congenital , Liver/abnormalities , Carcinoma, Hepatocellular/diagnostic imaging , Carcinoma, Hepatocellular/pathology , Carcinoma, Hepatocellular/surgery , Diagnosis, Differential , Hepatectomy , Hepatomegaly/diagnosis , Hepatomegaly/pathology , Humans , Laparoscopy , Liver/pathology , Liver/surgery , Liver Neoplasms/diagnostic imaging , Liver Neoplasms/pathology , Liver Neoplasms/surgery , RadiographyABSTRACT
INTRODUCTION: Bevacizumab, a humanized monoclonal antibody against vascular endothelial growth factor has demonstrated a significant benefit on overall survival (OS) and progression free survival (PFS) in patients with metastatic colorectal carcinoma. Many adverse effects of Bevacizumab are well-known. We report here the first case of diaphragmatic perforation after Bevacizumab treatment. PATIENTS AND METHODS: A case of Bevacizumab induced diaphragmatic perforation was reported and a search of PubMed and Cochrane databases was performed in order to review relevant literature on the adverse effects of Bevacizumab. DISCUSSION: Serious late surgical complications may occur even if the delay between surgery and Bevacizumab treatment is respected. These complications may be life threatening for patients, and demonstrate the importance of careful monitoring after postoperative administration of Bevacizumab.
