A 17-year-old boy is admitted to the hospital after a road traffic accident. Per abdomen examination is normal. After adequate resuscitation, his pulse rate is 80/min and BP is 110/70 mm Hg. Abdominal CT reveals 1 cm deep laceration in the left lobe of the liver extending from the dome more than halfway through the parenchyma.Appropriate management at this time would be
Correct Answer: Abdominal exploration and packing of hepatic wounds
Description: .Specific treatment for liver injury includes * Push (direct compression); plug (plugging the deep track injuries using silicone tube or SB tube); Pringles' manoeuvre; pack (liver wound is directly packed with a mop). * Laparotomy is done through a large bucket handle abdominal incision or thoracoabdominal incision, and extent of a liver injury and also other associated injuries are looked for. * Small liver tear is sutured with vicryl or PDS mattress sutures with placing of gel foam to control bleeding. * To control bleeding on the table, from the hepatic aery and poal vein, both are temporarily occluded using fingers, compressing at the foramen of Winslow --Pringle manoeuvre. Often bull-dog clamp or vascular clamps can be used. ref: SRB&;s manual of surgery, ed 3, pg no 528
Category:
Surgery
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