title: Iatrogenic liver trauma managed with mesh-wrapping and ligation of portal vein branch: A case report.
abstract: BACKGROUND
  Liver trauma is a critical condition that requires swift multidisciplinary approach. In complex hepatic injuries perihepatic packing is an established life-saving procedure. The aim of this study is to evaluate and highlight the value of absorbable mesh wrapping of the injured liver, combined with ipsilateral ligation of portal vein branch.
  
  
  METHODS
  An 82-year-old patient underwent an open cholocystectomy, for gallbladder empyema. The second postoperative day he was re-operated on due to active hemorrhage. The bleeding was controlled by suturing the bed of the gallbladder fossa. During this maneuver a portal vein branch was torn resulting in a rapidly expanding subcapsular liver hematoma which led to the formation of two deep lacerations on the liver parenchyma. This life-threatening condition was treated by wrapping an absorbable mesh around the right liver lobe and subsequently ligating the right portal vein branch extrahepaticaly.
  
  
  CONCLUSIONS
  Mesh wrapping of the fragmented liver with absorbable mesh constitutes a safe and effective method, in treating grade IV and V liver injuries, especially when combined with ipsilateral ligation of the bleeding vessel.
authors.affiliation: 2nd Department of Surgery, University of Athens, Aretaieio Hospital, 76 Vas. Sofias Ave., 11576, Athens, Greece.
authors.forename: D
authors.initials: D
authors.lastname: Dellaportas
authors.forename: C
authors.initials: C
authors.lastname: Nastos
authors.forename: V
authors.initials: V
authors.lastname: Psychogiou
authors.forename: A
authors.initials: A
authors.lastname: Tympa
authors.forename: A
authors.initials: A
authors.lastname: Tsaroucha
authors.forename: J
authors.initials: J
authors.lastname: Kontis
authors.forename: V
authors.initials: V
authors.lastname: Smyrniotis
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