Miha Petrič (Ljubljana / SI), Gregor Norčič (Ljubljana / SI), Lea Ivanovska (Ljubljana / SI), Martina Gubina (Ljubljana / SI), Velibor Tripković (Ljubljana / SI), Matej Kastelec (Ljubljana / SI), Anja Kramarič (Ljubljana / SI), Andriy Grynyuk (Ljubljana / SI), Rok Dežman (Ljubljana / SI), Mihajlo Đokić (Ljubljana / SI), Blaž Trotovšek (Ljubljana / SI)
Abstract text (incl. references and figure legends)
Case history.
22-years old male felt from 10 meters high. First responders assessed a patient and decided that there is high probability of severe blunt abdominal trauma. At arrival patient was present with signs of hypovolemic shock. FAST ultrasound showed a massive hematoperitoneum with lacero-contusion of right hemi liver. Massive transfusion protocol was activated.
Clinical findings.
Intraoperative finding showed severe lacero-contusion of right hemi liver with active bleeding. Partial avulsion of right kidney and bleeding from retroperitoneum.
Investigation/Results.
Abdominal computer tomography (CT) scan - Grade 5 AAST right hemi liver injury.
Diagnosis:
AAST Grade 5 right hemi liver injury
Therapy and Progressions.
Complete medial laparotomy and perihepatic packing was done, however it was not successful in providing adequate haemostasis. With use of Pringle manoeuvre we performed vascular exclusion of right hemi liver with right portal and hepatic vein and artery ligation. Combining vascular exclusion of right hemi liver and perihepatic packing we succeeded in reasonably good level of a haemostasis. Whole body CT was done and patient was transferred to intensive care unit (ICU). Hours later sings of active bleeding were noticed. CT scan and embolization of small arterial hepatic pseudoaneurysm were performed. After interventional procedure second operation was performed with additional haemostasis and perihepatic packing. In third operation local situation allowed complete mobilisation of right hemi liver and suture of thorn retro hepatic veins and vena cava. Signs of toxic shock prompt early surgical intervention (after 24h) with a right hepatectomy. No other surgical or invasive interventions were needed afterwards. He was transferred to ward on day 26 and was discharged on day 44 to rehabilitation centre.
Comments.
In our case report we show importance of multidisciplinary approach in a patient with blunt abdominal trauma and AAST grade 5 liver injury.
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.