Massive Liver Trauma—Multidisciplinary Approach and Minimal Invasive Surgery can Salvage Patients

Abstract

Management of massive liver trauma (grades IV-VI) is associated with high morbidity and mortality. It can pose serious challenges to treating physician and requires multimodality interventions. For a successful outcome, timing of intervention is crucial. We report a case of grade V hepatic injury treated successfully with angioembolization, laparoscopic lavage, and endoscopic stenting during a time period from admission to discharge on the 24th day. Angioembolization was performed at admission after resuscitation as CT scan showed active extravasation in the arterial phase. Laparoscopic lavage and drainage was performed on the fifth day as abdominal inflammatory response failed to respond to medical management. There was biliary component of abdominal fluid noticed during laparoscopy, which manifested by postoperative localized biliary fistula; hence endoscopic stenting of the bile duct was performed on the seventh day. The patient recovered well with timely minimal invasive approach and was fine at 1 year follow-up.

Closed abdominal trauma. Liver injuries. Part 1

“…Чем тяжелее травма, тем больше вероятность осложнений. Осложнения представлены повторным внутрибрюшным кровотечением [55], внутрипеченочной гематомой, ложными артериальными и венозными аневризмами [46], гемобилией, желчным свищом [39], биломой [68], внутрипеченочным абсцессом [40] Лечение осложнений травмы печени на современном этапе развития медицины осуществляют с использованием ангиографии с эндоваскулярной эмболизацией или стентированием, пункции и дренирования под контролем УЗИ, лапароскопии, эндоскопического стентирования [69,70]. Проводить такое лечение лучше в соответствующем стационаре, куда может быть переведен пострадавший после оказания ему квалифицированной медицинской помощи и стабилизации состояния.…”

Liver Trauma: Until When We Have to Delay Surgery? A Review

“…Following the recommendations provided at the 2020 World Society of Emergency Surgery (WSES) consensus conference, NOM should be the treatment of choice in hemodynamically stable patients with grade injuries I-V of the AAST classification when there are not any associated visceral lesions which need urgent surgery [ 5 , 7 ]. Additionally, the availability of hospital center resources must be taken into account: intensive care unit, endovascular techniques, blood products, as well as a team of expert surgeons [ 8 ]. In stable patients presenting with blushing or active bleeding on the CT scan, angioembolization should be considered as the gold standard treatment.…”

“…The procedure can be repeated if hemodynamic stability persists and the bleeding has not been solved. Diagnostic laparoscopy can be valued as an option in the context of NOM if, in close follow-up, there are reasonable doubts about the existence of possible associated visceral injuries [ 7 , 8 , 9 , 10 ].…”