Prolonged clamping of the liver. An alternative to severe hepatic trauma

Abstract

Objective: To describe the experience in management of liver trauma with prolonged clamping, at the service of Surgery 1, Hospital General del Este “Dr. Domingo Luciani Case report: A 28 years male patient who was admitted to the Unidad de Politraumatizados (UPT), after a motorcycle accident. Haemodynamically stable, physical examination: chest: vesicular murmur fallen, on right abdomen: signs of peritoneal irritation. Rx chest: hemoneumotórax; fracture of the third and the seventh rib arch rights; minimal thoracotomy: bubbling draining wealth and 500cc of liquid, FAST: moderate amount of free fluid. Exploratory laparotomy was performed with findings: 3000cc hemoperitoneum and grade IV liver injury, in the first phase of damage control, packing with clamping the liver as a strategy to control the bleeding and short closed. Second phase of damage control in the intensive care unit (ICU) for 48 hours, after which, in the third phase of damage control, with no findings of hemoperitoneum, 100cc bile secretion, hepatic lesion in segment VIII no bleeding. Lap pads are removed and haemostatic clamps, cleaning drainage cavity and closing with tension stitchs. Successfully outcome, discharged from the ICU, complicated with
biliary fistula resolved in the post elective endoscopic papilotomy. Conclusions: The prolonged clamping of the liver is an effective
strategy for controlling bleeding in cases of severe hepatic trauma in patients with liver resections warranted when the injuries
are confined in extreme liver.