Conservative Management of Major Liver Necrosis after Angioembolization in a Patient with Blunt Trauma

Abstract

Management of liver injury is challenging particularly for the advanced grades. Increased utility of nonoperative management strategies increases the risk of developing massive liver necrosis (MLN). We reported a case of a 19-year-old male who presented with a history of motor vehicle crash. Abdominal computerized tomography (CT) scan revealed large liver laceration (Grade 4) with blush and moderate free hemoperitoneum in 3 quadrants. Patient was managed nonoperatively by angioembolization. Two anomalies in hepatic arteries origin were reported and both vessels were selectively cannulated and bilateral gel foam embolization was achieved successfully. The patient developed MLN which was successfully treated conservatively. The follow-up CT showed progressive resolution of necrotic areas with fluid replacement and showed remarkable regeneration of liver tissues. We assume that patients with high-grade liver injuries could be managed successfully with a carefully designed protocol. Special attention should be given to the potential major associated complications. A tailored multidisciplinary approach to manage the subsequent complications would represent the best recommended strategy for favorable outcomes.

Abdominal Trauma: Five Years Experience in National Centre Hospital, Mauritania

“…In 2 (2%) of our patients their surgery was limited only to wound exploration as there was no evidence of peritoneal penetration and this compared well to other studies [18]. As reported by other study abdomen is the third most frequently injured body part among multiple trauma patients [19]. In blunt trauma several studies reported liver to be the most common injured solid organs, followed by spleen [13] [20] [21].…”

Challenges in management of blunt abdominal trauma: a prospective study

“…Among patients with multiple trauma, abdomen is the third most frequently injured body part next to musculoskeletal injury and head injury. 14 In present study spleen was found to be the most common injured abdominal organ followed by liver and hollow visceral injury, similarly several studies have reported spleen to be the most common organ injured. [14][15][16][17] However, a few studies have reported liver to be the most common injured solid organs followed by spleen in blunt abdominal trauma.…”

Operative and Nonoperative Management of Blunt Liver Injuries

“…Hepatic necrosis is a more severe complication that occurs after hepatic injury in addition to ischemia usually from embolization [17]. Necrosis presents in a variety of ways depending on the extent of hepatic involvement, from abdominal pain and feeding intolerance to Figure courtesy of Dr Andrew Dixon, Radiopaedia.org, rID: 32502 sepsis and multiorgan system failure [15]. While this devascularization can result in complete regeneration of hepatic parenchyma, surgical debridement may be warranted in more extreme cases when multiple lobes are involved or for fulminant liver failure [22].…”