Organ Specific Management
Hepatic Trauma
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. Adult blunt hepatic injury: A Western Trauma Association critical decisions algorithm. J Trauma 2023.
- Federico Coccolini, Raul Coimbra, et al. Liver trauma: WSES 2020 guidelines. World Journal of Emergency Surgery 2020.
- Nicole A. Stassen, MD; Indermeet Bhullar, MD; et al. Nonoperative management of blunt hepatic injury: An Easter Association for the Surgery of Trauma practice management guideline. J Trauma 2012.
- Thomas M. Scalea. Penetrating Liver Injuries. Curr Trauma Rep 2015.
- Christopher S. Green, MD, MBA; Eileen M. Bulger, MD, and Sharon W. Kwan, MD. Outcomes and complications of angioembolization for hepatic trauma: A systematic review of the literature. J Trauma 2016.
- Jason M. Samuels, MD; Heather Carmichael, MD; et al. Reevaluation of Hepatic Angioembolization for Trauma in Stable Patients: Weighing the Risk. J Am Coll Surg 2020.
- Gwendolyn M. van der Wilden, MSc; George C. Velmahos, MD, PhD; et al. Successful Nonoperative Management of the Most Severe Blunt Liver Injuries. Arch Surg 2012.
Splenic Injury
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
Kidney Injury
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:
- Additional Resources:
- 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.
Pancreatic Injury
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. 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. J Trauma 2022.
- Walter L. Biffl, MD; Frank Z. Zhao, MD; et al. A multicenter trial of current trends in the diagnosis and management of high-grade pancreatic injuries. J Trauma 2021.
- Alexis M. Moren, MPH, MD; Walter L. Biffl, MD; et al. Blunt pancreatic trauma: A Western Trauma Association critical decisions algorithm. J Trauma 2023.
- Walter L. Biffl, MD; Chad G. Ball, MD; et al. 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 injuries. J Trauma 2023.
- Kjetil Soreide, Thomas G. Weiser, and Rowan W. Parks. Clinical update on management of pancreatic trauma. HPB 2018.
- Chad G. Ball, MD, MSC, FRCSC, FACS; Walter L. Biffl, MD, FACS; et al. Does drainage or resection predict subsequent interventions and long-term quality of life in patients with Grade IV pancreatic injuries: A population-based analysis. J Trauma 2021.
- Vanessa Phillis Ho, MD, MPH; Nimitt J. Patel, MD; et al. Management of adult pancreatic injuries: A practice management guideline from the Eastern Association for the Surgery of Trauma. J Trauma 2016.
Gastric and Duodenal Injury
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
Genitourinary Injury
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
Colon and Rectal Injury
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. Colon Trauma: Evidence-Based Practices. Clin Colon Rectal Surg 2018.
- Michael S. Clemens, MD; Kaitlin M. Peace, MD; and Fia Yi, MD, FACS, FASCRS. Rectal Trauma: Evidence-Based Practices. Clin Colon Rectal Surg 2018.
- Ahmed Zeineddin, MD; Gail T. Tominaga; et al. Contemporary management and outcomes of penetrating colon injuries: Validation of the 2020 AAST Colon Organ Injury Scale. J Trauma Acute Care Surg 2023.
- 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. Destructive colon injuries requiring resection: Is colostomy ever indicated? J Trauma Acute Care Surg 2022.
- 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. Contemporary management of rectal injuries at Level I trauma centers: The results of an American Association for the Surgery of Trauma multi-institutional study. J Trauma Acute Care Surg 2018.
- Marc D. Trust, MD; Jacob Veith, MD; et al. Traumatic rectal injuries: Is the combination of computed tomography and rigid proctoscopy sufficient? J Trauma Acute Care Surg 2018.
- EAST Guidelines