Automated computer-aided diagnosis of splenic lesions due to abdominal trauma.

BACKGROUND: Computer-aided detection in the setting of trauma presents unique challenges due to variations in shape and attenuation of the injured organs based on the timing and severity of the injury.  We developed and validated an automated computer-aided diagnosis algorithm to detect splenic lesions such as laceration, contusion, subcapsular hematoma, perisplenic hematoma, and active extravasation using computed tomography (CT) images in patients sustaining blunt or penetrating abdominal trauma. METHODS: We categorized the splenic pathologies into three groups: contusion/laceration, hematoma, and active extravasation. We first analyzed the spleen and perisplenic region by estimating the mean value and standard deviation of the spleen. We determined adaptive threshold values based on the histogram of the area and detected the lesions after morphological operations and volumetric comparisons. RESULTS: The overall performance of the three computer-aided diagnosis (CAD) algorithms is an accuracy of 0.80, sensitivity of 0.95, specificity of 0.67, and a diagnostic odds ratio (DOR) of 40 with a 95 % confidence interval (CI): 14 to 117. The CAD of perisplenic hematoma had the highest diagnosis rates with an accuracy of 0.90, a sensitivity of 0.95,  specificity of 0.80, and DOR of 76 with a 95 % CI:  13 to 442. CONCLUSIONS: We developed a new algorithm to detect post-traumatic splenic lesions automatically and with high accuracy. Our method could potentially lead to the automated diagnosis of all traumatic abdominal pathologies. HIPPOKRATIA 2018, 22(2): 80-85.

Pyogenic liver abscess after gunshot injury: 10 years' experience at a single level 1 trauma center.

OBJECTIVES: Liver abscesses are approximately 50 % of all visceral abscesses, and trauma presents as a rare cause of the liver abscess. Otherwise, hepatic abscess is an uncommon complication of gunshot wound (GSW) to the liver among all trauma cases. Here we reviewed their experience in detail. METHOD: From January 1, 2004 to September 30, 2013, there were 2143 patients admitted to Ryder Trauma Center at Jackson Memorial Hospital/University of Miami with severe abdominal trauma: 1227 penetrating and 866 blunt. Among the patients who had penetrating trauma, 637 had GSWs and 551 had stab wounds. Thirty-nine patients had other kinds of penetrating traumas. Eleven patients were identified as having liver abscess, with 8 of them belonging to the GSW group, and 3 to the blunt injury group. The diagnosis and management of the 8 patients with a hepatic abscess after GSW to the liver were demonstrated. RESULT: There were seven males and one female with a mean age of 29 ± 10 years. There were one grade 2, four grade 3, two grade 4 and one grade 5 injuries. The mean abscess size was 10 ± 2 cm. The abscesses were usually caused by infection from mixed organisms. These abscesses were treated with antibiotics and drainage. No mortality and long-term morbidity were seen. CONCLUSION: Hepatic abscess after GSW to the liver is a rare condition, with an incidence of 1.2 %. It is usually seen in severe liver injury (grade 3 and above), but our patients were all treated successfully, with no mortality.

Using autologous peritoneal graft for portal vein injury due to blunt thoracoabdominal trauma.

BACKGROUND: Autologous vein or prosthetic materials are used as patch or tube graft for portal or caval vein reconstruction after trauma or tumor resection. Preparation of autologous veins requires extra incisions and is time consuming that is crucial especially in trauma patients. This condition adversely affects postoperative morbidity and mortality, particularly in trauma cases. Prosthetic materials may not be available in some centers, and their use is associated with an increased risk of infection. DESCRIPTION OF CASE: A 28-year-old hemodynamically unstable man presented to the emergency room with complete transection of main portal vein, right hepatic artery and common bile duct with tissue defect on hepatoduodenal ligament due to blunt thoracoabdominal trauma. Reconstructing of the portal vein was performed using an autologous peritoneal tube graft. CONCLUSION: Autologous peritoneal graft is a very good option in the treatment of major vascular injuries which can not be repaired with primary suturing. It is also easy to prepare and use, safe, without a need of additional incision, as an alternative to autologous veins and prosthetic materials especially under emergency conditions. Hippokratia 2015; 19 (3): 260-262.

A case report of a completely vanished liver graft after auxiliary partial orthotopic liver transplantation.

BACKGROUND: Auxiliary partial orthotopic liver transplantation is an alternative technique for the treatment of patients with fulminant hepatic failure and metabolic liver disease. It provides temporary support of liver function until sufficient regeneration of the native liver. Pediatric patients have a long life expectancy and are best candidates to benefit from the interruption of antirejection treatment. DESCRIPTION OF CASE: A 4-year-old boy underwent auxiliary partial orthotopic liver transplantation for fulminant hepatic failure using a cadaveric left lateral segment of liver. One year after auxiliary partial orthotopic liver transplantation, the patient's native liver was determined to be completely normal and he was doing well. The patient was then gradually weaned from the immunosuppression over the course of one year. The graft was undetectable on follow-up computerized tomography performed before complete cessation of immunosuppression, leading to the diagnosis of "vanishing graft syndrome". CONCLUSION: Graft atrophy commonly occurs after auxiliary partial orthotopic liver transplantation due to cessation of antirejection therapy. But to our knowledge, complete graft disappearance is a rare occurrence reported in the English literature. Timing for withdrawal of the immunosuppression is an important decision to be made in this technique. Hippokratia 2015; 19 (3): 274-277.