Successful Percutaneous Debridement of Major Hepatic Necrosis After Damage Control Laparotomy and Transcatheter Arterial Embolization：A Case Report

Abstract

A man in his early 50s was found lying at the railway station alongside the tracks and was transferred to our hospital. He was hemodynamically unstable and had abdominal tenderness, and focused assessment by sonography for trauma（FAST）was positive. Following fluid resuscitation, computed tomography（CT）was performed, which revealed grade Ⅲb liver injury, according to the classification of the Japanese Association for the Surgery of Trauma. Because the patient again developed hemodynamic instability after the CT examination, we performed emergency operation with direct liver suturing, perihepatic packing, and drainage tube placement. Control of the arterial bleeding that could not be managed by surgery was achieved by subsequent transcatheter arterial embolization（TAE）. Repeat abdominal CT on day 7 after admission revealed major hepatic necrosis（MHN）in the right lobe and a pseudoaneurysm in hepatic segment 8, which was managed by coil embolization. Considering the risk of intraoperative massive hemorrhage due to tight adhesions, surgery was avoided and conservative therapy, including percutaneous debridement and irrigation through the drainage tube, was continued. The patient was discharged on day 44. The irrigation treatment was continued at the ambulatory department and the drainage tube was removed approximately five months after the initial surgery. Percutaneous irrigative debridement of MHN is minimally invasive and may represent a useful therapeutic option.