Emergency liver transplantation combined with multivisceral resection after severe abdominal trauma: a case report

Liver transplantation (LT) after severe polytrauma is exceptionally rare. When damage-control surgery fails, multiorgan resection may be required as a life-saving procedure, with emergency LT representing the ultimate salvage option for patients with uncontrollable hepatic hemorrhage or irreversible liver failure. We report, to our knowledge, the first documented case of concomitant liver transplantation, splenectomy, nephrectomy, and total pancreatectomy following severe abdominal trauma.

A 19-year-old male sustained severe blunt abdominal trauma following a motorcycle-truck collision. Imaging revealed an AAST grade V liver injury with major vascular and biliary disruption, complete avulsion of the right renal artery (AAST V), splenic injury (AAST III) and an AAST grade II duodenal hematoma. Despite damage-control surgery, followed by splenectomy and right nephrectomy, definitive hemorrhage control could not be fully achieved. Given the persistent hepatic bleeding and the expected progression to acute liver failure secondary to extensive hepatic disruption, the patient underwent emergent LT. Due to concerns for progression of the duodenal injury, a planned second-look operation was performed 48 h later, revealing marked enlargement of the hematoma with impending duodenal wall rupture, prompting the decision to proceed with total pancreatectomy. The postoperative course was uneventful, and the patient was discharged 18 days after transplantation. At 29-month follow-up, both graft function and clinical status are excellent.

Emergency LT may represent a feasible and life-saving strategy in highly selected patients with devastating abdominal trauma. This case demonstrates that, despite the extreme surgical complexity, favorable long-term outcomes can be achieved, supporting the non-futility of transplantation in carefully selected trauma recipients.