Laparoscopic approach of a complex blunt liver, splenic and galbladder avulsion

Abstract text (incl. references and figure legends)

Male, 17 years old, victim of abdominal trauma (motorcycle crash against a wall IN high velocity), sustaining abdominal pain (peritoneal irritation), hemodynamic stability and no further apparent injuries. Abdominal CT scan (low available contrast) showed complex liver injury (Grade IV), moderate amount of free fluid around the liver and spleen and hematoma close to the gallbladder site with no clear definition of the gallbladder wall; no injuries were found in the head, neck and thorax CT.
The patient was carried to the Operate Room for a Diagnostic Laparoscopy. It was observed moderate amount of blood, complex stellate liver injury (deep laceration) in segments IV, V, VI and VII, presenting active bleeding, Grade II spleen injury (laceration with no active bleeding) at the gastric surface and gallbladder and liver parenchyma avulsion presenting active bleeding, with no apparent common bile duct injury.
After systematic diagnostic laparoscopy, no further injuries were identified. Liver injury was treated with simple interrupted suturing with catgut 3.0 achieving hemostasis after the proceeding. The splenic injury was treated with hemostatic agent and it was performed cholecystectomy with hemostasis of the liver surface with monopolar energy and hemostatic agent. Tubular intra-abdominal drainage was allocated at Morrisson´s space.
The patient in the PO1 was awake, presenting hemoglobin levels from 11 to 9, with no hemodynamic or clinic change, and no drain debt. The patient presented no abdominal pain, tubular drain debt of 5ml (bilious appearance), decreasing each day until no debt at PO7 when he was discharged.

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