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 done more than half way through the parenchyma. Appropriate management at this time would be:
Classification of liver injury (Moore) Grade Types Operative or CT Scan findings I Hematoma Laceration Subcapsular, <10% of surface area Capsular tear, < 1 cm in parenchymal death II Hematoma laceration Subcapsular, 10-50% of surface area Intraparenchymal, <10 cm in diameter 1-3 cm in parenchymal depth, <10 cm in length III Hematoma laceration Subcapsular, >50% of surface area or expanding; rupture subcapsular or parenchymal hematoma Intraparenchymal, hematoma > 10 cm or expanding > 3 cm in parenchymal depth IV Laceration Parenchymal disruption involving 25-75% of the hepatic lobe or 1-3 couinauds segments in a single lobe V Laceration vascular Parenchymal disruption involving >75% of the hepatic lobe or > 3 Coulnauds segments in a single lobe Juxta hepatic venous injuries, i.e retro hepatic vena cava / central major hepatic veins VI Vascular Hepatic avulsion
Conservative treatment
Abdominal exploration and packing of hepatic wounds
Abdominal exploration and ligation of left hepatic aery
Left hepatectomy
Trauma