Selective vascular occlusion with staged hemihepatectomy for blunt liver trauma.
BACKGROUND
A 23-year-old man with extensive blunt trauma to the right lobe of the liver in whom adequate haemostasis could not be achieved by selective suturing and packing was encountered. Contributing factors to poor haemostasis included massive transfusion, hypothermia and acidosis.


METHODS
Hepatic haemostasis was achieved by selective intrahepatic ligation of the right hepatic pedicle and packing.


RESULTS
After resuscitation and stabilization in the intensive care unit, a right hemihepatectomy was performed 14 h later.


CONCLUSIONS
The present case describes a modification of the Pringle manoeuvre, termed 'selective Pringle manoeuvre'. This technique is a useful additional strategy for the management of uncontrollable bleeding in massive hepatic trauma.
Martin
C J
CJ
Hepatobiliary and Upper Gastrointestinal Surgical Unit, Nepean Hospital, Penrith, New South Wales, Australia. cmartin@mail.usyd.edu.au
Cox
M R
MR
D000138:Acidosis / Q000150:complications; D000328:Adult; D001803:Blood Transfusion; D017809:Fatal Outcome; D005500:Follow-Up Studies; D006470:Hemorrhage / Q000601:surgery / Q000628:therapy*; D006488:Hemostasis, Surgical / Q000379:methods*; D006498:Hepatectomy / Q000379:methods*; D006801:Humans; D007035:Hypothermia / Q000150:complications; D008026:Ligation; D008099:Liver / Q000293:injuries* / Q000601:surgery; D008297:Male; D012421:Rupture; D013536:Suture Techniques; D013630:Tampons, Surgical; D014949:Wounds, Nonpenetrating / Q000601:surgery / Q000628:therapy*