A grade IV AAST/OIS liver trauma treated with ABTHERA™ device: A new therapeutic option in liver trauma?

Abstract text (incl. references and figure legends)

Case history:A 17-year-old came to our Trauma Center after a motor scooter collision which hesitated in a grade IV hepatic lesion and right renal hematoma. Due to hemodynamic instability, he had been previously operated in another hospital of Damage Control Surgery (DCS) with Peri Hepatic Packing (PHP). He had been transferred to our Trauma Center for an adequate centralization.

Clinical findings:He presented at the arrival a hemodynamic stability without catecholamines or inotropes, oro-tracheal intubated and sedated. Transfusion with 4 packed blood cells and 2 platelets was in progress.

Investigation/Results:CT body had been performed, which referred a major hepatic laceration of 11 cm in length across the IV-V Cuinaud segments and a right renal hematoma.

Diagnosis:At the relaparotomy a relevant volume of bile and blood was revealed. After the depacking an active haemorrhage was detected and a accurate surgical haemostasis and biliostasis was performed [fig.1]. The PHP was reperformed leaving the abdomen open with the ABTHERA™ device with instillation of 100 ml of saline solution per 5 minutes every 2 hours at -100 mmHg.

Therapy and Progressions:After 48 hours relaparotomy was performed. The abdomen was clean and the hepatic laceration lines were almost completely joined, with no need of more invasive procedures. Follow up at 6 months with MRI revealed a substantially healed liver [fig.2].

Comments: The ABTHERA™ device has proven in this case its feasibility and usefulness in physiology restoration and an unexpected therapeutic role in hepatic healing, promoting a natural adhesion of the hepatic laceration lines.

References:Predictive factors of morbidity and mortality in grade IV and V liver trauma undergoing perihepatic packing: single institution 14 years experience at European trauma centre. Injury. 2012 Sep;43(9):1347-54.Surgical management of AAST grades III-V hepatic trauma by Damage control surgery with perihepatic packing and Definitive hepatic repair-single centre experience. World J Emerg Surg. 2015 Aug 1;10:34

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