Organ Specific Management

The fellow should be able to:

• Demonstrate an understanding of the management differences between blunt and penetrating injuries to the liver
• Describe the indications for operative and non-operative management of liver injuries
• Describe the risk factors associated with failure of NOM in liver injury
• Understand the role of packing vs definitive control in liver injuries
• Describe the techniques necessary for vascular control of the liver
• Understand the role and complications associated with angioembolization in the management of liver injuries
• Recognize and know how to manage the complications associated with NOM and operative management of liver injuries

Resources

• Topic Summary
• Meet the Mentors - Operative Liver Trauma
• Meet the Mentors - Major Liver Injury: We Can Do Better
• Additional Resources
  • Natasha Keric, MD, FACS; David V. Shatz, MD; et al., J Trauma 2023.   Adult blunt hepatic injury: A Western Trauma Association critical decisions algorithm
  • Federico Coccolini, Raul Coimbra, et al., World Journal of Emergency Surgery 2020.  Liver trauma: WSES 2020 guidelines
  • Nicole A. Stassen, MD; Indermeet Bhullar, MD; et al., J Trauma 2012.  Nonoperative management of blunt hepatic injury: An Easter Association for the Surgery of Trauma practice management guideline
  • Thomas M. Scalea, Curr Trauma Rep 2015..  Penetrating Liver Injuries
  • Christopher S. Green, MD, MBA; Eileen M. Bulger, MD, and Sharon W. Kwan, MD., J Trauma 2016.  Outcomes and complications of angioembolization for hepatic trauma: A systematic review of the literature
  • Jason M. Samuels, MD; Heather Carmichael, MD; et al., J Am Coll Surg 2020.   Reevaluation of Hepatic Angioembolization for Trauma in Stable Patients: Weighing the Risk
  • Gwendolyn M. van der Wilden, MSc; George C. Velmahos, MD, PhD; et al., Arch Surg 2012.  Successful Nonoperative Management of the Most Severe Blunt Liver Injuries

The fellow should be able to:

• Demonstrate an understanding of the management differences between blunt and penetrating injuries to the spleen
• Describe the indications for operative and non-operative management of splenic injuries
• Describe the risk factors associated with failure of NOM in splenic injury
• Describe the role of splenic salvage and techniques in splenorraphy
• Understand the role and complications associated with angioembolization in the management of splenic injuries
• Recognize the complications associated with NOM and operative management of splenic injuries

Resources

• Topic Summary
• Meet the Mentors - Challenges in Nonoperative Management of the Spleen
• Meet the Mentors - Spleen Injuries
• Additional Resources:
  • Zarzaur B et al. An update on nonoperative management of the spleen in adults. Trauma Surgery and Acute Care open. 2017.
  • Nicole A. Stassen, MD; Indermeet Bhullar, MD; et al., Journal of Trauma and Acute Care Surgery 2012.  Selective nonoperative management of blunt splenic injury: An EAST practice management guideline
  • Susan E. Rowell, MD; Walter L. Biffl, MD; et al., Journal of Trauma and Acute Care Surgery 2017. Western Trauma Association Critical Decision in Trauma: Management of adult blunt splenic trauma – 2016 update
  • Coccolini F et al. Splenic trauma: WSES classification and guidelines for adult and pediatric patients. Would Journal of Emergency Surgery. 2017.
  • Indermeet S. Bhullar, MD; Eric R. Frykberg, MD; et al., Journal of Trauma and Acute Care Surgery 2012.  Selective angiographic embolization of blunt splenic traumatic injuries in adults decreases failure rate of nonoperative management
  • Arvierux C et al. Effects of prophylactic embolization on patients with blunt trauma at high risk of splenectomy. JAMA Surgery. 2020.
  • Schnuriger et al. Outcomes of proximal versus distal splenic artery embolization after trauma: a systematic review and meta-analysis. The Journal of Trauma.
  • Shapiro et al. Techniques of splenic conservation. Archives of Surgery. 1976.
  • Ko A et al. Near disappearance of splenorrhaphy as an operative strategy for splenic preservation after trauma. The American Surgeon. 2021.
  • Atkins K et al. Splenic salvage: is there a role for splenorrhaphy in the management of adult splenic trauma. The American Surgeon.
  • Lange DA et al. The use of absorbable mesh in splenic trauma. Journal of Trauma. 1988
  • Demetriades D et al. Splenic Injury. Atlas of Surgical Techniques in Trauma.
• EAST Guidelines:
  • Vaccination After Spleen Embolization

The fellow should be able to:

• Demonstrate an understanding of the management differences between blunt and penetrating injuries to the kidney
• Describe the indications for operative and non-operative management of kidney injuries
• Describe the techniques for vascular control of the kidney
• Understand the role and complications associated with angioembolization in themanagement of kidney
• Understand the options for management of urine leak and role of stenting
• Recognize the complications associated with NOM and operative management of kidney injuries

Resources

• Topic Summary
• Overview Article:
  • Federico Coccolini, Ernest E. Moore, et al., World J Emerg Surg 2019. Kidney and uro-trauma: WSES-AAST guidelines
• Additional Resources:
  • Darren J. Bryk and Lee C. Zhao., BJU Int 2016. Guideline of guidelines: a review of urological trauma guidelines
  • Feliciano D, Mattox K, & Moore E (2020). Trauma, ninth edition (9th ed.). Chapter 40: Genitourinary Tract. McGraw-Hill Education.
  • Allen F. Morey, Steve Brandes, et al. American Urological Association., J Urol 2014.  Urotrauma: AUA Guidelines
  • U. Rozzanigo, G. Luppi, et al., Clin Radiol. 2021 Traumatic renal artery dissection: from imaging to management
  • Daniel M. Stein and Richard A. Santucci., Curr Opin Urol 2015. An Update on Urotrauma
  • Efraim Serafetinides, Noam D. Kitrey, et al., Eur Urol 2015.  Review of the current management of upper urinary tract injuries by the EAU Trauma Guidelines Panel
• Multimedia Resources:
  • Renal Trauma, Emory Virtual Lecture Series, Lindsey Hartsell, MD, June 2020 
  • Upper Tract Trauma, Urology Collaborative Online Virtual Didactics (COVid), UCSF, Andrew Cohen, MD, May 2020
  • Lower Tract Trauma, Urology Collaborative Online Virtual Didactics (COVid), VCU, J. Tyler Roseman, MD, April 2020 
  • Pediatric Renal Trauma, Urology Collaborative Online Virtual Didactics (COVid), University of Washington, Judith Hagedorn, MD, May 2020 
  • Kidneys & Urinary System. University of Michigan Medical School. M1 Anatomy. Glenn Fox, Ph.D. 2020.
    • Locations and Positions
    • Internal Gross Anatomy
    • Renal Vasculature
    • Excretory Pathway
    • Urinary Autonomics

The fellow should be able to:

• Demonstrate an understanding of the management differences between blunt and penetrating injuries to the pancreas
• Describe the indications for operative and non-operative management of pancreatic injuries
• Describe the importance of ductal injury and options for assessing the pancreatic duct
• Describe the operative techniques necessary for pancreatic trauma as determined by location and grade of injury
• Understand the management of destructive injuries to the pancreatic head, the role of the trauma Whipple, and damage control techniques
• Understand the management of complications after NOM and operative management of pancreatic injuries

Resources

• Topic Summary
• Meet the Mentors - Pancreatic Trauma
• Meet the Mentors - Pancreatic Trauma
• Additional Resources:
  • Walter L. Biffl, MD; Chad G. Ball, MD; et al., J Trauma 2022.   A comparison of management and outcomes following blunt versus penetrating pancreatic trauma: A secondary analysis from the Western Trauma Association Multicenter Trials Group on Pancreatic Injuries
  • Walter L. Biffl, MD; Frank Z. Zhao, MD; et al., J Trauma 2021.  A multicenter trial of current trends in the diagnosis and management of high-grade pancreatic injuries
  • Alexis M. Moren, MPH, MD; Walter L. Biffl, MD; et al., J Trauma 2023.  Blunt pancreatic trauma: A Western Trauma Association critical decisions algorithm
  • Walter L. Biffl, MD; Chad G. Ball, MD; et al., J Trauma 2023.  Current use and utility of magnetic resonance cholangiopancreatography, and pancreatic duct stents: A secondary analysis from the Western Trauma Association multicenter trials group on pancreatic inju
  • Kjetil Soreide, Thomas G. Weiser, and Rowan W. Parks., HPB 2018.  Clinical update on management of pancreatic trauma
  • Chad G. Ball, MD, MSC, FRCSC, FACS; Walter L. Biffl, MD, FACS; et al., J Trauma 2021.  Does drainage or resection predict subsequent interventions and long-term quality of life in patients with Grade IV pancreatic injuries: A population-based analysis
  • Vanessa Phillis Ho, MD, MPH; Nimitt J. Patel, MD; et al., J Trauma 2016..  Management of adult pancreatic injuries: A practice management guideline from the Eastern Association for the Surgery of Trauma

The fellow should be able to:

• Demonstrate an understanding of the diagnosis and management of gastric injuries
• Demonstrate an understanding of the diagnosis and management of duodenal injuries
• Describe operative techniques for duodenal injury
• Describe the management of duodenal hematoma
• Recognize the importance of assessing the common bile duct/ampulla during duodenalrepair
• Describe the technique of pyloric exclusion and recognize controversies around pyloric exclusion
• Describe the management of complications related to gastric/duodenal repairs

The fellow should be able to:

• Demonstrate an understanding of the management differences between blunt and penetrating injuries to the bladder
• Describe the indications for operative and non-operative management of bladder injuries
• Understand the techniques for operative repair of bladder injuries and the role for urinary diversion
• Recognize the complications associated with NOM and operative management of bladder injuries
• Describe the technique for initial management and repair of ureteral injuries

Resources

• Topic Summary
• Meet the Mentors - Duodenal Trauma

The fellow should be able to:

• Demonstrate an understanding of the diagnosis and management of colonic injury
• Demonstrate an understanding of the unique nature of rectal injury and specific management of intra- vs extra-peritoneal injury
• Describe the options for assessing for rectal injury
• Describe options for surgical management of penetrating rectal injury
• Describe the role of ostomies in colonic and rectal injury
• Describe the technique of pre-sacral drainage and controversies about this procedure
• Describe the management of complications related to colonic or rectal repairs

Resources

• Topic Summary
• Meet the Mentors - Complex Colon Injuries
• Additional Resources:
  • Ryo Yamamoto, MD; Alicia J. Logue, MD, FACS; and Mark T. Muir, MD., Clin Colon Rectal Surg 2018. Colon Trauma: Evidence-Based Practices
  • Michael S. Clemens, MD; Kaitlin M. Peace, MD; and Fia Yi, MD, FACS, FASCRS., Clin Colon Rectal Surg 2018. Rectal Trauma: Evidence-Based Practices
  • Ahmed Zeineddin, MD; Gail T. Tominaga; et al., J Trauma Acute Care Surg 2023.  Contemporary management and outcomes of penetrating colon injuries: Validation of the 2020 AAST Colon Organ Injury Scale
  • 2023 - Dhanasekara CS, et al. Anastomotic leak rates after repair of mesenteric bucket-handle injuries: A multi-center retrospective cohort study. Am J Surg. 2023 May 28:S0002-9610(23)00218-0. doi: 10.1016/j.amjsurg.2023.05.032. Epub ahead of print. PMID: 37270399.
  • Delbrynth P. Mitchao, MD; Meghan R. Lewis, MD; et al., J Trauma Acute Care Surg 2022. Destructive colon injuries requiring resection: Is colostomy ever indicated?
  • 2021 - Filiberto DM, Afzal MO, Sharpe JP, Seger C, Shankar S, Croce MA, Fabian TC, Magnotti LJ. Radiographic predictors of therapeutic operative intervention after blunt abdominal trauma: the RAPTOR score. Eur J Trauma Emerg Surg. 2021 Dec;47(6):1813-1817. doi: 10.1007/s00068-020-01371-8. Epub 2020 Apr 16. PMID: 32300849.
  • Penetrating Rectal Injury: 2022 - Nguyen J, Bashan KA, Jiang C, Lin M, Tootla Y, Udobi K, Williams KN, Gelbard R, Nguyen CT, Sola R Jr, Smith RN, Sciarretta JD, Butler C, Morse BC, Grant AA, Rhee P. Rectal Contrast CT Scans of Limited Utility in Diagnosing Colonic Injuries in Penetrating Trauma: A Meta-Analysis. Am Surg. 2023 Jun;89(6):2284-2290. doi: 10.1177/00031348221086792. Epub 2022 Apr 18. PMID: 35437027.
  • Carlos V.R. Brown, MD; Pedro G. Teixeira, MD; et al., J Trauma Acute Care Surg 2018. Contemporary management of rectal injuries at Level I trauma centers: The results of an American Association for the Surgery of Trauma multi-institutional study
  • Marc D. Trust, MD; Jacob Veith, MD; et al., J Trauma Acute Care Surg 2018.  Traumatic rectal injuries: Is the combination of computed tomography and rigid proctoscopy sufficient?
• EAST Guidelines
  • Management of Penetrating Intraperitoneal Colon Injuries
  • Penetrating Extrapertoneal Renal Injuries