Management of liver trauma

Williamson, James M.; Rees, Jon; Streets, Christopher G.; Strickland, Andrew; Finch-Jones, Meg

doi:10.12968/hmed.2013.74.8.432

Cited by 2 publications

(2 citation statements)

References 27 publications

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“…The liver is the most frequently damaged organ in abdominal trauma [ 4 ], and the most widely used classification system for liver injury is the AAST-OIS [ 5 ]. Grade I or II injuries are relatively inconsequential, such as minor capsular tears, that do not require operative treatments.…”

Section: Discussionmentioning

confidence: 99%

“…In liver trauma, while nonoperative management is preferred for stable patients, laparotomy should be performed for unstable patients, especially for injuries greater than grade III as measured by the American Association for the Surgery of Trauma–Organ Injury Scale (AAST-OIS). The three most frequently used damage control surgical techniques for liver trauma are: (1) perihepatic packing, (2) hepatorrhaphy with or without hepatotomy, and (3) debridement hepatectomy [ 4 ]. Although different operative methods for major vessel injuries and associated mortality in liver trauma have been reported in previous studies, there have been few reports that explain the details of IVC suture repair.…”

Section: Introductionmentioning

confidence: 99%

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Case report: direct suture repair of inferior vena cava to rescue a stab patient with hepatic and caval injury through left hepatectomy and total vascular exclusion

et al. 2021

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Background The mortality of abdominal vena caval injuries is as high as 50–80%. Yet, there were few reports on how to repair injured inferior vena cava (IVC). This report presents a method of vena caval repair in a case of penetrating retrohepatic IVC injury, requiring hepatic resection and total vascular exclusion (TVE). Case presentation The patient was a 20-year-old man with a stab wound in the epigastrium. An emergency laparotomy was performed in the emergency room, and a stab incision on the left liver was detected. As the Pringle’s maneuver did not reduce bleeding, hepatic vein injury was suspected, and left hemihepatectomy was performed to confirm the bleeding point. After the hepatectomy, laceration was still evident deeper into the resection, and IVC injury was suspected. The bleeding was temporarily controlled by tentative hepatorrhaphy and gauze packing, and the initial damage control surgery was terminated. Definitive surgery was performed on the third postoperative day. The lacerated point was observed under TVE, and the laceration penetrated the retrohepatic IVC through its posterior wall. The slit of the posterior wall was sutured first, followed by suturing of the anterior wall of the IVC. Finally, the lacerated liver was closed with hepatorrhaphy. TVE was removed, and the massive bleeding was successfully controlled. Conclusion In severe liver injuries involving the retrohepatic IVC, hepatic resection and TVE may be useful for ensuring an optimized surgical field for repairing the injured IVC.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%