Title: Perihepatic Packing: A Life Saving Procedure in Liver Trauma
Authors: Dr Anant S. Ramani, Dr Vishal Sardesai
DOI: https://dx.doi.org/10.18535/jmscr/v12i01.04
Abstract
Objective: Liver is one of the most common organ injured in Blunt and penetrating abdominal trauma and is the 2nd most common cause of mortality in these patients. The main objective of this study is to analyse the role and success rate of perihepatic packing in liver trauma
Materials & Methods: This is a prospective study conducted on 200 patients of Liver trauma admitted in a tertiary care hospital over 2 year period with 3 months postoperative followup. Most of the High Grade liver injuries with uncontrolled venous bleeding were subjected to perihepatic Packing. The patient were shifted to ICU postoperatively and reexplored after 48 hours for pack removal.
Results: 30 patients were subjected to Perihepatic packing with success rate of 80% in achieving haemostasis.24 cases were due to blunt while 6 due to penetrating trauma. Commonly seen in younger age group with male dominance. Majority of the injuries were AAST Grade III and IV type.
Discussion: In Liver trauma the prime goal is Life Saving by control of Haemorrhage. Various advanced procedures are performed for the same, however it may not be possible to carry out all these in an emergency setting of Haemodynamically unstable patients. In these selected cases, Perihepatic packing is the Gold standard to achieve haemostasis as damage control or Definitive procedure.
Conclusion: Perihepatic Packing is a highly recommended procedure in selected cases of High Grade liver injuries mainly for control of venous bleeding. Good postoperative ICU ventilator support under Broad spectrum Antibiotic cover is mandatory to minimize morbidity and mortality associated with the procedure.
Keywords: Liver trauma, Perihepatic Packing, Blunt abdominal trauma, Reexploration.
References
- Ahmed N, Vernick JJ et al : Management of Liver trauma in Adults. Journal of Emergency Trauma, 2011 ;4(1) : 114-9.
- Abdel – Misih SR, Bloomston M. Liver Anatomy. Surg Clinics North America 2010; 90(4): 643-53.
- Kristina Doklestic, Vladinir Djukic, Nenad Ivancevic, Pavle Gregoric, Zlatibor Loncar,Branislava Stefanovic et al : Severe Blunt trauma in Polytrauma Patient – Management and outcome. Srp Arh Celok Lek. 2015 Jul-Aug; 143 (7-8) : 416-422.
- Federico Coccolini, Giulia Matori, Fausto Catena, Salomone Di Saverio, Walter Biffi, Ernest E. Moore et al : Liver Trauma :WSES position paper . World Journal of Emergency Surgery (2015) 10: 39.
- S Buci, M. Torba, A. Gjata, I. Kajo, Gj.Bushi and K. Kagjini. The rate of success of the conservative management of Liver trauma in a developing country.World Journal of Emergency surgery 2017, 12:24.
- Bilal O.Al-Jiffry.Diagnosis and treatment of liver injuries. Saudi Surgery Journal 2017; 5: 53-59.
- Mehrdad Hosseinpour, Mohammad Reza Asgarzadeh, Mahdi Mohammadzadeh, Farzad Parvizian. Archives of Trauma Research. 2012;1(1):31-34.
- Asensio JA, Roldan G, Petrone P, Rojo E, Tillou A, Kuncir E et al Operative management and outcome in 103 AAST Grade IV & V complex hepatic injuries. Trauma Surgeon still need to operate but Angioembolisation helps. Journal of Trauma, Injury,Infection and critical care . April 2003,54(4): 647-654.
- Schweizer W, Tanner S, Baer HU, Lerut J, Huber A,Gertsch P et al . Management of traumatic liver injuries.British Journal Surg 1993; 80:86-88.
- Shapiro MB, Jenkins DH,Schwab CW, Rotondo MF. Damage control :Collective review. J Trauma.2000;49:969-78.
- Hellnig TS,Morse C . Treatment of liver injuries at Level I & II Centres in a multiinstitutional metropolitan trauma system.The Midwest Trauma Society Liver trauma study Group. J. Trauma 1997;42: 1091-96.