Management of Traumatic Liver Injury Flashcards
Why might some patients require operative intervention even after successful angioembolization?
Due to ongoing hemorrhage or an associated hollow viscus injury
What is a common complication following angioembolization in liver trauma patients?
Liver necrosis
What additional exposure can be obtained if needed for access to the retrohepatic vena cava or suprahepatic vena cava?
A right subcostal extension, right thoracotomy, or median sternotomy can provide additional access.
What is the first step in managing liver trauma after opening the abdomen?
Dividing the falciform ligament along the anterior surface of the liver to allow for more effective packing and minimizing traction injury
How should the liver be packed during trauma surgery?
The liver should be sandwiched between anterior and posterior laparotomy pads, ensuring not to occlude the inferior vena cava (IVC)
How can minor liver lacerations be managed intraoperatively?
Using electrocautery, argon beam coagulation, topical hemostatics, or sutures for parenchymal approximation.
What can be used for immediate hemorrhage control in penetrating liver trauma?
A balloon catheter (Foley, Blakemore, or Penrose drain) placed through the tract and inflated until resistance is felt
What is required for total hepatic vascular isolation?
Occlusion of the supraceliac aorta, porta hepatis, and infrahepatic and suprahepatic IVC
What is an atriocaval shunt used for, and how is it performed?
It is used for retrohepatic IVC injuries. A chest tube is placed from the right atrial appendage into the IVC, secured with a purse-string suture and Rummel tourniquet
What extreme option may be considered for uncontrollable liver hemorrhage with complete liver destruction?
Total hepatectomy with portocaval shunt and possible liver transplantation
What can be used in addition to hemostatics to control bleeding from a liver laceration?
A tongue of omentum can be used to provide hemostasis.
What type of sutures are recommended for reapproximating liver parenchyma?
Large, blunt-tipped absorbable sutures such as 0 chromic or 0 PDS.
How can complex liver lacerations with devitalized tissue be addressed?
Using finger fracture techniques to delineate viable tissue and obtaining hemostasis through sutures, surgical clips, or other techniques.
What devices can be used for peripheral liver injuries to remove nonviable tissue or perform a tractotomy?
A vessel-sealing device or GIA stapler
What are potential acute complications in liver trauma patients?
Profound coagulopathy from massive blood loss, resuscitation, and acute liver damage, including ischemia-reperfusion injury
