[Central liver lesion by a high velocity bullet with massive hemorrhage: what is the solution?]

The management of severe hepatic trauma may represent a challenge in the presence of haemodynamic instability, coagulopathy, hypothermia or metabolic failure. Moreover, the choice of treatment should consider the prevention of complications. The omentum has many advantages including hemostasis, infection preventing, viability and adaptability to reconstruction as a space filler. We report the case of a 19 year-old patient who sustained a gunshot wound, involving the right elbow and forearm and the abdomen with burst of right kidney and a penetrating centro-hepatic injury (stage IV). Surgical treatment was successfully performed in two times, by gauze packing for temporary control of haemostasis and after 24 hours by omental packing to fill the dead space of hepatic lesion. The viable omentum was placed through the hepatic hole and fixed posteriorly to the skin. The postoperative period was uneventful, excluding the development of a biliary fistula which resolved after external drainage. We conclude that omental packing is a valid solution when dealing with penetrating liver injury.