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Therapeutic perihepatic packing in complex liver trauma
J E Krige1, P C Bornman, J Terblanche
1Department of Surgery, University of Cape Town, South Africa.
The British Journal of Surgery
|January 1, 1992
Summary
Therapeutic liver packing effectively controls hemorrhage in liver trauma patients, especially those with coagulopathy. This life-saving technique allows for initial resuscitation and planned reoperation.
Area of Science:
- Trauma Surgery
- Hepatobiliary Surgery
- Surgical Hemorrhage Control
Background:
- Liver trauma presents significant surgical challenges, often complicated by coagulopathy.
- Hemorrhage control is critical for patient survival following liver injury.
Purpose of the Study:
- To evaluate the efficacy and outcomes of therapeutic liver packing for hemorrhage control in liver trauma patients.
- To assess the role of packing in managing coagulopathic bleeding in liver trauma.
Main Methods:
- Retrospective analysis of 22 patients undergoing liver packing for trauma over six years.
- Indication for packing, trauma mechanism, injury patterns, and outcomes were recorded.
- Complications, rebleeding rates, and mortality were analyzed.
Main Results:
- Packing achieved definitive bleeding control in 18 of 22 patients.
- Recurrent bleeding occurred in four patients, managed with further surgery or embolization.
- Mortality was 27% (6/22), with recurrent bleeding a contributing factor in two deaths.
- Major morbidity occurred in 12 survivors, including intra-abdominal sepsis in seven.
Conclusions:
- Therapeutic liver packing is a life-saving intervention for hepatic bleeding, particularly when aggravated by coagulopathy.
- It facilitates initial resuscitation and allows for planned re-exploration for definitive management.
- While effective, packing is associated with significant morbidity, necessitating careful patient selection and monitoring.