Damage Control Surgery and Liver Trauma

**37**

**Chapter 3**

**Abstract**

**1. Introduction**

Trauma

Damage Control Surgery for Liver

The liver is one of the most commonly injured organs of the abdomen after major trauma and may lead to the extravasation of major amounts of blood. Damage control surgery (DCS) as a concept exists for over one hundred years but has been more widely optimized and implemented over the past few decades. Minimizing the time from the trauma scene to the hospital and recognizing the patterns of injury and the "lethal triad" (acidosis, hypothermia, coagulopathy) is vital to understand which patients will benefit the most from DCS. Immediate patient resuscitation, massive blood transfusion, and taking the patient to the operating room as soon as possible are the critical initial steps that have been associated with improved outcomes. Bleeding and contamination control should be the priority in this first exploratory laparotomy, while the patient should be transferred to the intensive care unit postoperatively with only temporary abdominal wall closure. Once the patient is stabilized, a second operation should be performed where an anatomic liver resection or other more major procedures may take place,

**Keywords:** liver trauma, hypothermia, acidosis, coagulopathy, perihepatic packing

Despite its well-protected position, the liver is the most frequently affected abdominal organ by blunt or penetrating trauma [1, 2]. Over the past decades, the improvements in the assessment and management of hepatic injury have evolved significantly, thus resulting in better outcomes for affected patients [3]. The majority of such injuries develop following high-energy traffic accidents or violent behaviors [4]. Industrial and farming accidents also consist of a significant percentage of liver trauma. Blunt injuries are the majority of cases in Europe, Australia, and Asia, whereas penetrating injuries (stab and gunshot wounds) are

Blunt trauma, as a result of traffic accident or fall from a height, may lead to deceleration injury due to the inertia of the liver [4]. The affected sites usually involve the attachments to the diaphragm and abdominal wall. These types of injury typically involve the right lobe, especially the posterior segments, and the caudate lobe, while a vascular injury may also be present with the respective hepatic arteries, portal and hepatic veins being affected [4, 7, 8]. The site of connection between inferior vena cava and hepatic veins is vulnerable to blunt traumas and may lead to serious venous injuries and a significant blood loss. Penetrating injuries are more frequently associated with significant vascular injuries at the liver site inflicted [4].

most frequently encountered in North America and South Africa [5, 6].

along with permanent closure of the abdominal wall.

*Ioannis A. Ziogas, Ioannis Katsaros and Georgios Tsoulfas*
