Complications of Hepatic Surgery and Trauma
Stephen M. Cohn, Matthew O. Dolich in Complications in Surgery and Trauma, 2014
A bile leak after liver injury is usually manifested by bile in perihepatic drains placed intraoperatively or percutaneously, by a localized perihepatic fluid collection (biloma), or by generalized ascites (bile peritonitis). These biliary complications are associated with high-grade liver injuries (4%–24%),5,15 and are mostly due to an intrahepatic source. The more complex the liver injury, the higher the incidence of biliary complications (5% in grade three injuries vs. 52% in grade five injuries, in one study).5 Patients with bilomas may have no symptoms or may exhibit right upper quadrant fullness or tenderness, fever, or jaundice, weeks after the initial operation or injury. CT or ultrasound-guided drainage is the treatment of choice if the patient exhibits symptoms, fever, or leukocytosis, with initiation of empiric antibiotics.
Emergency Surgery
Tjun Tang, Elizabeth O'Riordan, Stewart Walsh in Cracking the Intercollegiate General Surgery FRCS Viva, 2020
What are the potential delayed complications of blunt hepatic trauma?Complications occur in more than 10% of patients, particularly after high-grade injury. Although routine imaging is not recommended, clinical indications (abdominal pain, fever, jaundice, a drop in haemoglobin) indicate a follow-up CT scan.Complications include biloma and necrosis from devascularisation, complicated by abscess formation. Abscesses and biloma can be treated by drainage (percutaneous or surgical), and some biliary complications requiring ERCP stenting. Most rebleeding or secondary haemorrhage (e.g. rupture of subcapsular haematoma or pseudo-aneurysm) can be treated non-operatively, with or without embolisation.Pseudo-aneurysms, haemobilia and liver compartment syndrome in large sub-capsular haematomas are less common.In general, patients who have been well may go back to normal activity by 3–4 months, as follow-up studies generally show that the liver would have healed by then.
Abdominal trauma
Brice Antao, S Irish Michael, Anthony Lander, S Rothenberg MD Steven in Succeeding in Paediatric Surgery Examinations, 2017
The most frequent complication of non-operative management of blunt trauma of the liver, other than bleeding, is a bile leak. The development of fever, ileus, right upper quadrant pain and persistently elevated liver function tests after liver trauma should arouse suspicion for liver-related complications. An ultrasound or CT scan should be performed to evaluate for a possible biloma or abscess. If a fluid collection is found, it can usually be drained percutaneously under ultrasound guidance. The nature of the fluid retrieved determines the diagnosis (i.e. bile with biliary leak; gross pus with abscess). HIDA scan is also a useful for detection of biliary leaks. ERCP may be both diagnostic and therapeutic. If a bile leak is identified by ERCP, a sphincterotomy may be performed to facilitate ampullary drainage, and an endoscopic stent may be placed. Abscess may occur due to an infected biloma but can also be secondary to infected necrosis of the liver when the liver is devitalised by trauma. Some patients will ultimately require hepatic resection to remove the necrotic part of the liver. Gangrenous cholecystitis may occur secondary to injury to the right hepatic artery or cystic artery. Acalculous cholecystitis may also occur in multiply injured patients who have a prolonged length of stay in the intensive care unit, although this is not usually attributed to liver trauma. Haemobilia is acute gastrointestinal bleeding arising from the biliary tract that may occur after major liver injury. Patients classically present with right upper quadrant pain, jaundice and acute gastrointestinal bleeding. Diagnosis is made by either angiography or upper endoscopy.
The local efficacy and influencing factors of ultrasound-guided percutaneous microwave ablation in colorectal liver metastases: a review of a 4-year experience at a single center
Published in International Journal of Hyperthermia, 2019
Si Qin, Guang-Jian Liu, Meijin Huang, Jun Huang, Yanxin Luo, Yanling Wen, Yimin Wang, Limei Chen
There were no deaths that correlated with ablation. Major and minor complications occurred in 5 cases (3.65%) and 11 cases (8.03%), respectively (Table 4). The mean size of the lesion was 17.81 ± 8.20 mm in diameter for patients with complications and 15.02 ± 6.91 mm for those without complications (p = .101; 95% CI: −0.9 1 to 9.33). The treatment of 11 lesions near important structures resulted in complications, which were significantly more common than in those not located near important structures (p = .016; 95% CI: 1.35–10.29). Biloma occurred in 25.00% (2/8) of lesions near the intrahepatic bile duct and pleural effusion occurred in 11.11% (3/27) of lesions near the diaphragm. Fever and pain were the most common side effects after MWA. Seventeen (12.41%) patients showed a range in temperature of 37.2–39.9 °C, which occurred 24–48 h after MWA and persisted for 1–7 days. Seventy-three (53.28%) patients experienced local pain following MWA (Table 5).
Beneficial body mass index to enhance survival outcomes in patients with early-stage hepatocellular carcinoma following microwave ablation treatment
Published in International Journal of Hyperthermia, 2020
Jian-Ping Dou, Zhi-Yu Han, Fangyi Liu, Zhigang Cheng, Xiaoling Yu, Jie Yu, Ping Liang
The rate of major complications according to the society of interventional radiology classification was 4.2% (20/474). No treatment related deaths were detected in all patients. Eleven patients were detected with pleural effusion and all recovered after aspiration (n = 4) or drainage (n = 7). Tumor seeding was diagnosed in two patients and both received MWA treatments after diagnosis. Biloma occurred in two patients and was cured after 2–3 months of drainage. Hepatic abscess was detected in two patients and was cured after drainage and use of antibiotics. Bleeding occurred in two patients and one was cured after injection of thrombin to the bleeding site, the other was cured after TACE treatment. Ascites occurred in one patient and recovered after drainage and albumin infusion.
Microwave ablation using two simultaneous antennas for the treatment of liver malignant lesions: a 3 year single-Centre experience
Published in International Journal of Hyperthermia, 2023
Flavio Andresciani, Giuseppina Pacella, Daniele Vertulli, Carlo Altomare, Maria Teresa Bitonti, Amalia Bruno, Laura Cea, Eliodoro Faiella, Bruno Beomonte Zobel, Rosario Francesco Grasso
Furthermore, another interesting result was that all the patients who had complications have had a significant higher incidence of previous treatments (p < 0.05), especially for the cases of biloma: among the 7 patients with this complication, 5 had already underwent a liver procedure (i.e. 3 cases of previous surgery, 1 case of percutaneous ablation and 1 case of radiotherapy) and that ablated HCC lesions had bilomas in statistically fewer cases than metastases (T = −2.44, p = 0.022, mean 0 vs 0.19). These data may be explained by the cytoarchitectural alteration of the liver subsequent to the local treatment, and suggest that performing double-probe MWA on patient who did not already undergo a surgical or percutaneous procedure on the liver would be a safer option, especially when treating a LM.
Related Knowledge Centers
- Biliary Fistula
- Biliary Tract
- Liver Biopsy
- Abdominal Cavity
- Cholecystectomy
- Bile Duct
- Bile
- Incidence
- Abdominal Trauma
- Quadrants & Regions of Abdomen