Packing and temporary closure in a liver injury.
As a component of a staged laparotomy for trauma, perihepatic packing can be lifesaving in the patient with exsanguinating liver injury who, due to hypothermia and coagulopathy, is unable to tolerate a more extensive procedure. However, if intra-abdominal pressure increases, the manoeuvre has been reported to compromise cardiopulmonary stability. Patients who suffer the adverse consequences of intra-abdominal hypertension are commonly managed with a loose temporary closure, frequently using an artificial material to bridge the skin defect across the incision. A case is reported where these two seemingly contradictory options were combined to achieve a successful outcome.
Sheridan
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R
Department of Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, USA.
Driscoll
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D
Felsen
R
R
D000063:Accidents, Traffic; D000328:Adult; D004487:Edema / Q000601:surgery; D004638:Emergency Treatment; D005260:Female; D006801:Humans; D007422:Intestines / Q000293:injuries*; D007813:Laparotomy; D008099:Liver / Q000293:injuries*; D009104:Multiple Trauma / Q000601:surgery*; D012086:Reoperation; D013154:Spleen / Q000293:injuries*