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
.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
Conservative treatment
Abdominal exploration and packing of hepatic wounds
Abdominal exploration and ligtation of left hepatic aery
Left hepatectomy
G.I.T