2008 Volume 28 Issue 7 Pages 943-946
A 62-year-old male arrived at the emergency department of our hospital with injuries to his precordia and upper abdomen after crashing head-on into a tree while driving a light vehicle under the influence of alcohol. The patient exhibited shock on primary survey. Although hemodynamics transiently stabilized following initial fluid therapy, they immediately destabilized. Therefore, the patient underwent emergency laparotomy as a transient responder. Laparotomy revealed that injury to the middle and left hepatic veins was responsible for the bleeding, and that injury to the hepatic parenchyma, including the hepatic artery, was relatively mild. Because the injured area could be easily determined by dorsally elevating the liver, initial surgery involving repair with direct suture was performed without damage control. Severe hepatic injury primarily involving injury to the hepatic vein may be a factor contributing to a transient response. As selection of treatment during the acute phase is of critical importance, establishment of clear fixed standards is necessary in the future.
