THERAPEUTIC ROLE OF PERIHEPATIC PACKING TAMPONADE IN SEVERE LIVER TRAUMA

Abstract

In this report, the therapeutic role of perihepatic packing placement and its effectiveness on the prognosis in major liver injuries were investigated. Uncontrollable hemorrahage following hepatic trauma remains a difficult problem in association with high morbidity and mortality rates. Placement of perihepatic packing may be a life-saving procedure in patients with sudden massive bleeding from the injured liver. We report 18 patients of liver trauma in whom perihepatic packing was used over a 5 year period. All patients were evaluated respectively. Of the 18 patients, 15 suffered blunt abdominal trauma, 3 had penetrating trauma including two gunshot wounds and one stab wound. The complexity of liver injury was classified as Grade IV in thirteen patients and as Grade V in five patients. Packing, itself proved to be successful in controlling bleeding in 11 patients in whom packs were removed at a second laparotomy at a mean of two days after initial operation. On the contrary, when 7 patients required further surgery at subsequent exploration (right lobectomy in one, left trisegmentectomy in one, nonanatomical resectional debridment in one, late matress suture was employed in four patients). Four patients died of miscellaneous complications. Cause of death was respiratory failure in two patients, ARDS in one and heart failure in one. Theurapeutic perihepatic packing tamponade seems to be a safe, reliable and effective modality allowing possibility for resuscitation of hypovolemic shock and providing time for correction of other metabolic disturbances and coagulopathic conditions in a subset of patients with major hepatic trauma.