2023 Volume 51 Issue 2 Pages 49-56
In this case of traumatic liver injury, the form of injury changed from type Ib to type IIIb within a short time.
Case: A man in his twenties was hit on the front right side of his trunk by material at a construction site and was transported to our emergency department. Upon arrival, his consciousness was clear and vital signs were stable. CT revealed intraparenchymal injury near the middle hepatic vein, but as the hepatic capsule was not ruptured, we determined the presence of type Ib traumatic liver injury and initiated non-operative management (NOM). Follow-up CT scan 46 hours after injury revealed that the hematoma had increased in size but remained under the capsule. The patient's subjective symptoms had subsided and his vital signs remained stable, so we decided to continue NOM. At 77 hours after injury, his abdominal pain began to worsen, and CT revealed type IIIb liver injury. His vital signs indicated shock, so we performed an emergency laparotomy. Hemostasis of the injured liver was obtained by suturing the torn middle hepatic vein. Gauze packing was used to wrap the surface of the right lobe and the medial area, and he was returned to the ICU. We removed the gauze packing on postoperative day (POD) 2. The patient's postoperative progress was good, and he was discharged from hospital on POD 22 and returned to normal life two months later.
Conclusion: When determining whether to continue NOM, it is important to assess both anatomic damage and physiologic circulatory kinetics.
