Liver through and through lesion due to a stab wound. Old haemostatic resources in the arteriography era

Abstract text (incl. references and figure legends)

16-year-old male patient who arrived at the emergency room after suffering penetrating abdominal trauma with a knife at hight school.

He was assessed using the ATLS principles; A: Airway clear, C-Spine cleared clinically. B: Respiratory rate 15bpm. C: Hemodynamic instability. Blood pressure 90/60mmHg, heart rate 120bpm. D: E: Temperature 36.7ºC. 2cm stabwound at epigastrium. No other wounds were found.

E-FAST: Positive in the abdomen.

An emergent surgery was performed.

By mid-line laparotomy, the abdominal cavity was exposed. All the blood and clots were removed, and the abdominal cavity was packed to stop the bleeding. Then, the abdominal cavity was explored sequentially. A through-and-through wound on the left liver (segments II-III) was adverted, not involving the cava vein. There was an active venous bleeding. No other haemorrhagic injuries were found.

The bleeding stopped with compression but continued after removing the packing. It was hard to control due to the depth of the wound. We decide to use a balloon tamponade (Poggetti et al 1992). A urinary catheter was introduced inside a sterile glove finger and the open end was sealed using a silk suture. This device was inserted through the liver wound and the glove finger was inflated with saline solution. The balloon was left in place for 15 minutes, while we took a secondary look, in search for any intestinal injury. The pressure reduced the bleeding however not stop in completely. We then decide to use a haemostatic matrix based on thrombin solution to completely fill the wound.

After the surgery, our patient was haemodynamically stabilized, and he was discharged 4 days after.

The surgical management in liver traumatic injuries is difficult, and each time less frequent due to the extent of the arteriography. However, it is still sometimes necessary. With this case, we would like to highlight some of the different resources available.

Disclosure: Do you have a significant financial interest, consultancy or other relationship with products, manufacturer(s) of products or providers of services related to this abstract? (If not, please enter "No" in the text field.)

No