Damage control surgery - massive pulmonary embolism complicated by sever bleeding from the liver

Area of Science:

• Emergency Medicine
• Trauma Surgery
• Critical Care

Background:

• A patient presented with sudden collapse and loss of consciousness, diagnosed with massive bilateral pulmonary embolism.
• Initial resuscitation included cardiopulmonary resuscitation (CPR) and thrombolysis, followed by transfer to the intensive care unit (ICU).

Purpose of the Study:

• To describe a complex case of massive pulmonary embolism complicated by traumatic hemoperitoneum requiring extensive surgical intervention.
• To highlight the management challenges and outcomes in a critically ill patient with multiple organ injuries.

Main Methods:

• Initial management involved CPR, thrombolysis, and stabilization in the emergency department.
• Subsequent management included urgent laparotomy, perihepatic packing, and multiple surgical revisions for liver lacerations and bleeding.
• Conservative management and critical care support were crucial throughout the patient's ICU stay.

Main Results:

• Massive hemoperitoneum was identified secondary to liver lacerations caused by fractured ribs.
• The patient underwent multiple surgical interventions, including laparotomy, packing, and liver resection.
• Hemodynamic stabilization was ultimately achieved, with recovery and initiation of long-term anticoagulation therapy.

Conclusions:

• This case underscores the critical management of rare complications arising from pulmonary embolism and associated trauma.
• Multidisciplinary care involving emergency medicine, surgery, and critical care is essential for managing such complex cases.
• Despite severe injuries, a combination of aggressive surgical and conservative management can lead to favorable outcomes.