Background and Objectives: Abdominal trauma among severely injured patients with an injury severity score (ISS) of 16 and above can lead to potentially life-threatening injuries that might need immediate surgical intervention. Traumatic injuries to the diaphragm (TID) are a challenging condition often accompanied by other injuries in the thoracoabdominal region. Materials and Methods: We retrospectively analyzed the occurrence and clinical course of TID among severely injured patients treated at our center between 2008 and 2019 and compared them to other groups of severely injured patients without TID. Results: Thirty-five patients with TID and a median ISS of 41 were treated in the period mentioned above. They were predominantly middle-aged men and mostly victims of blunt trauma as a consequence of motor vehicle accidents. A total of 70.6% had left-sided TID, and in 69.6%, the size of defect was larger than 10 cm. The diagnosis was made with computed tomography (CT) in 68.6% of the cases, while in 25.8%, it was made intraoperatively or delayed by a false-negative initial CT scan, and in 5.7%, an intraoperative diagnosis was made without preoperative CT imaging. Surgical repair was mostly conducted via laparotomy, performing a direct closure with continuous suture. A comparison to 191 patients that required laparotomy for abdominal injuries other than TID revealed significantly higher rates of concomitant injuries to several abdominal organs among patients suffering from TID. Compared to all other severely injured patients treated in the same period (n = 1377), patients suffering from TID had a significantly higher median ISS and a longer mean duration of hospital stay. Conclusions: Our findings show that TID can be seen as an indicator of particularly severe thoracoabdominal trauma that requires increased attention from the treatment team so as not to miss relevant concomitant injuries that require immediate intervention.

Living donor liver transplantation (LDLT) is an established and endorsed alternative for deceased donor liver transplantation with better recipient outcomes. Nevertheless, while extensive evaluation of potential donors is crucial, evaluation algorithms differ between transplant centres and guidelines. We included 317 individuals evaluated for LDLT between 07/2007-07/2022 in a retrospective analysis. The evaluation process was analysed to identify the key reasons for declining 77 potential donors. Additionally, 146 donors that underwent LDLT were analysed regarding risk factors for complications. The main reasons for donor refusal were liver volumetry (40.3 %) and metabolic factors including obesity or steatotic liver disease (20.8 %). Contrast-enhanced computed tomography (CECT) identified 63.6 % of all declined donors; CECT combined with assessment of medical history, physical examination, blood testing and ultrasonography, identified 87.0 % of declined potential donors. Associated with this selection, complication rates in donors were low (≥II in 17.1 %; none with ≥IVb). Notably, higher age was a risk factor for developing a complication ≥II after hemi-hepatectomy (p = 0.0373). We propose a progressive 4-step evaluation algorithm that begins with a very basic assessment combined with up-front CECT. This early phase of testing is expected to identify nearly 90 % of ineligible donors, thereby conserving critical resources, time and money, as well as minimising burden for potential donors. J.M.W. received funding by grant We-4675/6-1 from the Deutsche Forschungsgemeinschaft (DFG) in Bonn, Germany.

Background: Abdominal trauma, leading to intra-abdominal bleeding, is a life-threatening condition that might need emergency surgical intervention. Sonography and Computed Tomography (CT) are most commonly used to detect free intra-abdominal fluid. This study investigates the accuracy of CT to distinguish between ascites and intra-abdominal hemorrhage. Methods: Ascites were collected during a clinical routine. Three serial dilutions, mixing ascites with whole blood samples of the patient and with two blood group identical donors, were prepared. Laboratory-chemical analysis and radiological evaluation using CT with measurement of average Hounsfield Units (HU) were performed. Results: Between ascites and whole blood as well as between ascites and the 1:1-ratio-samples, HU values differed significantly (p < 0.001). All further dilutions showed HU values with no significant difference compared to ascites (p ≥ 0.42). Whole blood showed significantly higher HU values than ascites and every step of the serial dilutions (p < 0.001). Measured HU values were also dependent on time and the exact point of measurement in the micro reaction vessels. Conclusions: In patients suffering from blunt abdominal trauma with preexisting ascites, HU values in CT imaging are not valid enough to exclude an acute hemorrhage.

Background: Pediatric liver transplantations generally represent advanced surgery for selected patients. In case of acute or chronic graft failure, biliary or vessel complications, a retransplantation (reLT) can be necessary. In these situations massive adhesions, critical patient condition or lack of good vessels for anastomosis often are problematic.Methods: Between 2008 and 2021, 208 pediatric patients received a liver transplantation at our center. Retrospectively, all cases with at least one retransplantation were identified and stored in a database. Indication, intra‐ and postoperative course and overall survival (OS) were analyzed.Results: Altogether 31 patients (14.9%) received a reLT. In 22 cases only one reLT was done, 8 patients received 2 reLTs and 1 patient needed a fourth graft. Median age for primary transplantation, first, second and third reLT was 14 (range: 1–192 months), 60.5 (range: 1–215 months), 58.5 (range: 14–131 months) and 67 months, respectively. Although biliary atresia (42%) and acute liver failure (23%) represented the main indications for the primary liver transplantation, acute and chronic graft failure (1st reLT: 36%, 2nd reLT: 38%), hepatic artery thrombosis (1st reLT: 29%, 2nd reLT: 25%, 3rd reLT: 100%) and biliary complications (1st reLT: 26%, 2nd reLT: 37%) were the most frequent indications for reLT. OS was 81.8% for patients with 1 reLT, 87.5% with 2 reLTs and 100% with 3 reLTs.Conclusion: Pediatric liver retransplantation is possible with a good outcome even after multiple retransplantations in specialized centers. Nevertheless, careful patient and graft selection, as well as good preoperative conditioning, are essential.

In the setting of severe trauma, abdominal injuries are common and potentially life-threatening. Such injuries predominantly affect parenchymal organs, particularly the liver and spleen. Hollow organ injuries occur less frequently but nevertheless require timely and accurate diagnosis as well as appropriate surgical management to avoid severe complications, including peritonitis and sepsis. In daily clinical practice, different surgical strategies are employed for the management of hollow organ injuries. According to overall injury severity and abdominal injury patterns, treatment may involve either definitive single-stage surgery or staged procedures incorporating damage control principles. This study aimed to retrospectively evaluate the incidence and patterns of surgical management of hollow organ injuries in severely injured patients and to describe postoperative course and complications associated with different treatment strategies. Between 2006 and 2020, 1794 patients aged ≥ 16 years with an Injury Severity Score (ISS) ≥ 16 were treated at University Medical Center Regensburg, a level 1 trauma center. Among these, 57 patients sustained transmural hollow organ and/or mesenteric injuries requiring surgical intervention. Definitive surgical management during the initial operation was performed in 20 patients, whereas 37 patients underwent staged management with at least one planned secondary procedure. Patients managed with staged approaches exhibited higher overall injury severity and more complex abdominal injury patterns, including combined hollow organ and/or mesenteric injuries in 24.3%. Surgical treatment comprised bowel repair, resection with anastomosis, ostomy formation, or combinations of these techniques, carried out either during the initial operation or during planned subsequent procedures. No bowel leakage requiring revision surgery occurred following single-stage management. By contrast, bowel leakage necessitating unplanned reoperation was observed in 4 of 37 patients (10.8%) treated with staged approaches. In this retrospective single-center analysis, single-stage definitive surgical management was mainly observed in patients with moderate overall injury severity and less complex abdominal injury patterns, whereas staged strategies incorporating damage control principles were more frequently applied in patients with higher injury severity and complex abdominal injuries. These findings indicate that single-stage management may represent a feasible option in selected severely injured patients, while more complex injury patterns are more commonly managed using an individualized, staged surgical approach.