Outcomes following liver trauma in equestrian accidents.
Abstract: Equestrian sports are common outdoor activities that may carry a risk of liver injury. Due to the relative infrequency of equestrian accidents the injury patterns and outcomes associated with liver trauma in these patients have not been well characterized. Methods: We examined our experience of the management of equestrian liver trauma in our regional hepatopancreaticobiliary unit at a tertiary referral center. The medical records of patients who sustained liver trauma secondary to equestrian activities were analysed for parameters such as demographic data, liver function tests, patterns of injury, radiological findings, the need for intervention and outcomes. Results: 20 patients sustained liver trauma after falling from or being kicked by a horse. The majority of patients were haemodynamically stable on admission. Alanine transaminase (ALT) levels were elevated in all patients and right-sided rib fractures were a frequently associated finding. CT demonstrated laceration of the liver in 12 patients, contusion in 3 and subcapsular haematoma in 2. The right lobe of the liver was most commonly affected. Only two patients required laparotomy and liver resection; the remaining 18 were successfully managed conservatively. Conclusions: The risk of liver injury following a horse kick or falling off a horse should not be overlooked. Early CT imaging is advised in these patients, particularly in the presence of high ALT levels and concomitant chest injuries such as rib fractures. Despite significant liver trauma, conservative management in the form of close observation, ideally in a high-dependency setting, is often sufficient. Laparotomy is only rarely warranted and associated with a significantly higher risk of post-operative bile leaks.
Publication Date: 2014-08-21 PubMed ID: 25177363PubMed Central: PMC4148498DOI: 10.1186/1752-2897-8-13Google Scholar: Lookup
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- Journal Article
Summary
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The research is about the study of liver trauma outcomes following accidents in equestrian sports. It reveals patterns, required care measures, and eventual health results from these specific injuries.
Methodology
- The study was conducted in a regional hepatopancreaticobiliary unit at a third-level referral center, specialized in the management of liver, pancreas and biliary tract pathologies.
- The medical records of patients who had experienced liver trauma due to equestrian accidents were examined.
- Various parameters were analyzed. These included demographic data, liver function tests, injury patterns, radiological findings, the requirement for intervention, and overall patient outcomes.
Results
- 20 patients were found to have suffered liver trauma as a result of either a fall from a horse or a horse’s kick.
- The majority of patients were hemodynamically stable when admitted to the hospital. This means their heart rate, blood pressure, and body temperature were within normal ranges.
- All patients exhibited elevated Alanine transaminase (ALT) levels. This enzyme is found in high amounts in the liver and is a key marker of liver injury when its levels are raised.
- There was a common association of liver injury with right-sided rib fractures.
- Computed Tomography (CT) scans showed 12 patients had a laceration of the liver, 3 had contusions, and 2 had subcapsular hematomas, which are blood pools beneath the liver capsule.
- The right lobe of the liver was affected most frequently in these cases.
- Only two patients required an open surgical procedure (laparotomy) and liver resection, which involves removal of a portion of the liver. The other 18 patients were successfully managed with conservative methods that did not involve surgery.
Conclusion
- The study shows the importance of not overlooking the risk of liver injury in equestrian accidents involving a horse kick or falling from a horse.
- Early use of CT imaging is recommended, especially in situations of high ALT levels and chest injuries like rib fractures.
- Even with significant liver trauma, conservative management involving careful observation, preferably in a high-dependency setting like an intensive care unit, is often enough. Surgical intervention is rarely required, and comes with a higher risk of post-operative complications such as bile leakage.
Cite This Article
APA
Balakrishnan A, Abbadi R, Oakland K, Jamdar S, Harper SJ, Jamieson NV, Huguet EL, Jah A, Praseedom RK.
(2014).
Outcomes following liver trauma in equestrian accidents.
J Trauma Manag Outcomes, 8, 13.
https://doi.org/10.1186/1752-2897-8-13 Publication
Researcher Affiliations
- Department of Hepatopancreaticobiliary Surgery, Addenbrooke's Hospital and Cambridge University, Hills Road, Cambridge CB2 0QQ, UK.
- Department of Hepatopancreaticobiliary Surgery, Bristol Royal Infirmary, Marlborough Street, Bristol BS2 8HW, UK.
- Department of Hepatopancreaticobiliary Surgery, Addenbrooke's Hospital and Cambridge University, Hills Road, Cambridge CB2 0QQ, UK.
- Hepatobiliary Surgery Unit, Manchester Royal Infirmary, Oxford Road, Manchester M13 9WL, UK.
- Department of Hepatopancreaticobiliary Surgery, Addenbrooke's Hospital and Cambridge University, Hills Road, Cambridge CB2 0QQ, UK.
- Department of Hepatopancreaticobiliary Surgery, Addenbrooke's Hospital and Cambridge University, Hills Road, Cambridge CB2 0QQ, UK.
- Department of Hepatopancreaticobiliary Surgery, Addenbrooke's Hospital and Cambridge University, Hills Road, Cambridge CB2 0QQ, UK.
- Department of Hepatopancreaticobiliary Surgery, Addenbrooke's Hospital and Cambridge University, Hills Road, Cambridge CB2 0QQ, UK.
- Department of Hepatopancreaticobiliary Surgery, Addenbrooke's Hospital and Cambridge University, Hills Road, Cambridge CB2 0QQ, UK.
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Citations
This article has been cited 2 times.- Oshima K, Murata M, Aoki M, Nakajima J, Sawada Y, Isshiki Y, Ichikawa Y, Hagiwara S. Report of Four Cases with Equestrian Injury: Therapeutic Approach and Outcome. Case Rep Emerg Med 2018;2018:8283179.
- Oode Y, Maruyama T, Kimura M, Fukunaga T, Omori K, Yanagawa Y. Horse kick injury mimicking a handle bar injury or a hidden speared injury. Acute Med Surg 2016 Jan;3(1):3-9.
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