The current status and management of blunt adrenal gland trauma

• Published in: Surgery 2015-02, Vol.157 (2), p.338-343
• Main Authors: Liao, Chien-Hung, MD, Ouyang, Chun-Hsiang, MD, Fu, Chih-Yuan, MD, Wang, Shang-Yu, MD, Lin, Kuo-Jen, MD, Kuo, I-Ming, MD, Hsu, Chih-Po, MD, Yang, Shang-Ju, MD, Yuan, Kuo-Chin, MD, Hsu, Yu-Pao, MD
• Format: Article
• Language: English
• Subjects: Adrenal Gland Diseases - diagnosis; Adrenal Gland Diseases - diagnostic imaging; Adrenal Gland Diseases - therapy; Adrenal Glands - blood supply; Adrenal Glands - diagnostic imaging; Adrenal Glands - injuries; Adult; Angiography; Cohort Studies; Embolization, Therapeutic; Female; Hemorrhage - diagnosis; Hemorrhage - diagnostic imaging; Hemorrhage - therapy; Humans; Injury Severity Score; Male; Middle Aged; Prognosis; Prospective Studies; Surgery; Treatment Outcome; Wounds, Nonpenetrating - diagnosis; Wounds, Nonpenetrating - diagnostic imaging; Wounds, Nonpenetrating - therapy; Young Adult
• ISSN: 0039-6060; 1532-7361
• DOI: 10.1016/j.surg.2014.09.001

Background Blunt adrenal gland trauma (BAGT) is a potentially devastating event if unrecognized during the treatment course of patients with trauma. Because of its rarity, no current algorithm or consensus exists for BAGT. In the present study, we demonstrated the feasibility and safety of transcatheter angiographic embolization (TAE) in BAGT and analyzed the clinical presentation and outcome of BAGT. Methods We conducted a prospective collection and retrospective review at a level I trauma center in Taiwan. This study included all of the patients that sustained BAGT from May 2004 to May 2013. We retrieved and analyzed the patient demographic data, clinical presentation, BAGT grade, injury severity score, management, hospital stay, and mortality. Results The cohort consisted of 77 patients: 59 men and 18 women. The mean age was 34.3 ± 15.5 years. The right side was the predominant site of injury (59/77; 76.6%). Six patients underwent operation; 18 patients underwent angiography, including four TAEs, and the remaining patients underwent conservative management. The mortality rate was 9.1% (7/77), and a high injury severity score was an independent factor to predict mortality. Conclusion In conclusion, BAGT is a rare injury with a benign prognosis. Most patients can be treated conservatively. Furthermore, this study demonstrates that both TAE and operation can be used to achieve hemostasis. The mortality of BAGT was related to severe associated injuries. BAGT is an indicator of severe multiple trauma; however, it does not increase mortality or prolong hospital stay.