|
|
 |
 |
 |
|
Western Trauma Association
Management of Adult Blunt Hepatic Trauma
Annotation
for Point H
Neither
the presence nor the absence of active bleeding on CT
scanning absolutely predicts the need for angiography.
Vasospasm at the time of CT and delayed clot lysis can
both contribute to an initial lack of contrast
extravasation, whereas active bleeding may be due to
hemorrhage from portal or hepatic vein lesions. Bleeding
seen during the arterial phase of the scan, however,
confirms bleeding from an arterial source.
Angioembolization is an important adjunct to management
of patients managed both operatively and nonoperatively
with high-grade liver injuries. Early angioembolization
can decrease the need for transfusions and liver-related
operations.29,30 Conflicting data exist as to
whether it can improve outcome in patients requiring
operative intervention.20,31,32 Unless
angiography is immediately available, most would
consider preoperative angiography only for stable
patients with pooling seen on CT scanning. There are
several reports, however, suggesting that angiography be
used as an extension of resuscitation in patients with
ongoing resuscitative needs.33,34 This
practice cannot be advocated except in selected centers.
|
|
 |
|
 |
|
