Healing of Blunt Liver Injury After Non-Operative Management: Role of Ultrasonography Follow-Up.

BACKGROUND: Non-operative management of patients with blunt liver trauma has become the standard of care. Usually after initial computed tomography (CT) evaluation and a short-term intra-hospital instrumental and clinical monitoring, no other imaging assessment is routinely requested. A restriction of physical activities for a few (unfixed number of) months is the most common recommendation. A few studies investigated the re-establishment of normal hepatic parenchymal architecture, but there is no evidence of the correct length of time for a certain resumption to normal life. To understand the progression of traumatic liver damage and the time course of healing, and to indicate the correct spontaneous recovery time, a long-term sonographic followup was done. METHODS: Forty-four patients with blunt non-operatively managed hepatic injury were selected by a retrospective review of a prospectively collected database. At admission, in accordance with the American Association for the Surgery of Trauma (AAST), all lesions were evaluated by CT and graded by the Organ Injury Scale (OIS). The progression of liver repair was followed by ultrasonographic (US) controls on days 3, 5, 10, 15, 30, and 60, and monthly up to a complete clinical recovery and sonographic disappearance of lesions. RESULTS: One OIS grade I, 20 grade II, 13 grade III, eight grade IV, and two grade V hepatic injuries were included in the study. Forty patients were monitored until liver normalization by 218 US examinations. The median time for liver repair in OIS grades II, III, IV, and V was 30, 63, 62, and 118 days, respectively, and 75% of the patients recovered in 60, 80, and 98 days in the II, III, and IV classes, respectively. CONCLUSION: In our experience, a long time variability for spontaneous liver repair after blunt trauma and non-operative treatment was found, but a parenchymal US normalization was evidenced in a median time shorter than that usually reported in the literature.

[Role of the severity score and of the multiple organ dysfunctions in the treatment of severe acute pancreatitis and its infective complications]. / Ruolo dei punteggi di gravità e dell'insufficienza multipla d'organo nel trattamento della pancreatite acuta severa e della sua complicanza infettiva.

INTRODUCTION: There is considerable controversy about timing of surgery in acute pancreatitis. Scoring system is widely used in Intensive Care Units (ICU) but above all in order to assess the severity of disease. AIM OF THE STUDY: In this prospective clinical study, modification of clinical evolution and scores (APACHE II, SAPS II and SOFA) are analyzed. Scores were computed, daily or every other day. Two particular phases were observed: the day of ICU admission and the day of surgical treatment. MATERIAL AND METHODS: Twenty-one patients are studied; they were all surgically treated only after identification of positive pancreatic coltures. Open-packing was performed 2-6 weeks after the beginning of acute pancreatitis. In six patients who died, a progressive deterioration was noticed between admission and identification of infected necrosis. All scores were higher in patients who died, in particular a significant difference was found between SOFA score at admission and at treatment (mean +/- SD: 5.0 +/- 3.2 vs 8.5 +/- 3.0, p < 0.05). CONCLUSIONS: In conclusion when clinical conditions are critical a high SOFA score could contribute to indicate surgical treatment even without identification of sepsis.