The incision was extended to the right subcostal area for better exposure and mobilization of the liver. All 4 quadrants were packed and the source of bleeding was identified to be the hepatic parenchyma. In OR, an exploratory laparotomy was performed by a midline incision starting from the xiphoid process to 4 cm below the umbilicus. Fluid resuscitation was initiated but he did not respond hence massive transfusion protocol (MTP) was activated and an immediate decision was taken to move him to the operating room (OR) for exploratory laparotomy by the trauma team, which was lead by consultant trauma and acute care surgeon. A lax anal tone was also found on the digital rectal examination and the findings were suggestive of spinal injury as well. He had numbness in his lower legs and unable to move his bilateral lower limbs. There was generalized tenderness with distension and absent gut sounds. Abdominal examination showed a single entry wound on his mid-epigastrium, 3 cm below the xiphoid process, and no exit wound identified. During the examination, he was agitated with a heart rate of 100 beats/min, BP of 70/35 mm Hg, and respiratory rate of 30 breaths per minute. On arrival, advanced trauma life support system protocols were initiated and immediate resuscitation was started. He was shifted to the Emergency room of a tertiary care hospital within 20 min after sustaining the injury. The incident occurred while pursuing a terrorist in Karachi, early morning at around 6.30 Am. This uncommon method of managing liver injuries was found to be safe, effective, and more importantly time-saving for the patient.Ī 45 years old policeman, with no prior medical and significant family history, was brought to the trauma bay in the ER after sustaining a single gunshot injury to his abdomen from a high-velocity weapon. We report a case of a patient as per SCARE 2018 criteria, who sustained a high-grade hepatic injury and underwent damage control surgery, where the GIA stapler device was used to perform non-anatomical liver resection and control active bleeding. Operative management for managing Grade IV hepatic injuries and non-responders associated with active hemorrhage and hemodynamic instability includes multiple surgical techniques ranging from initial packing, manual compression, Pringle’s maneuver, direct suturing, balloon inflation, use of energy devices to ligation of vessels and hepatic resection. Therefore, despite our progress in liver injury management, many avenues for improvement remain to be explored. However, high-grade liver injuries which include major parenchymal disruption, retrohepatic venous injuries, and those involving the portal triad continue to remain a challenge and despite technological advances, associated with high mortality. ![]() The management of liver trauma continues to evolve with improved techniques of diagnosis and management, both operatively and nonoperatively. Large surface area and more anterior location beneath the subcostal margin make the liver a more susceptible organ to sustain both blunt or penetrating injuries. Liver injury occurs in approximately 5% of all trauma admissions.
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