EVALUATION, MODIFICATION, AND DECISION-MAKING IN DAMAGE CONTROL STRATEGY : HEPATIC INJURY MANAGED BY TAE, PHP, OAM, AND RESECTIONAL DEBRIDEMENT - A CASE REPORT

Abstract

　　Treatment strategies for life-threatening liver injuries remain controversial and challenging. A man in his 50s, with a history of heavy drinking, suffered a blunt thoracoabdominal injury in a single motor vehicle crash. Transarterial embolization was performed for the posterior branch of the right hepatic artery because of an intraparenchymal hematoma with active arterial bleeding. After eight hours, perihepatic packing was conducted due to rebleeding. Six hours later, open abdomen management was administered for abdominal compartment syndrome. Forty hours later, a planned reoperation was performed, which included resectional debridement for liver injury and transcystic C-tube drainage. Drain management for liver infarction and infection was performed as a bridging treatment, and the patient was subsequently discharged in a favorable condition. It is suggested that continuous assessment and modification of the damage control strategy for severe liver injury helps achieve favorable outcomes.