title: Massive Liver Trauma-Multidisciplinary Approach and Minimal Invasive Surgery can Salvage Patients.
abstract: Management of massive liver trauma (grades IV-VI) is associated with high morbidity and mortality. It can pose serious challenges to treating physician and requires multimodality interventions. For a successful outcome, timing of intervention is crucial. We report a case of grade V hepatic injury treated successfully with angioembolization, laparoscopic lavage, and endoscopic stenting during a time period from admission to discharge on the 24th day. Angioembolization was performed at admission after resuscitation as CT scan showed active extravasation in the arterial phase. Laparoscopic lavage and drainage was performed on the fifth day as abdominal inflammatory response failed to respond to medical management. There was biliary component of abdominal fluid noticed during laparoscopy, which manifested by postoperative localized biliary fistula; hence endoscopic stenting of the bile duct was performed on the seventh day. The patient recovered well with timely minimal invasive approach and was fine at 1 year follow-up.
authors.affiliation: Department of Minimal Invasive surgery, Critical Care, Radiology and Endoscopy, Jupiter Hospital, Thane Maharashtra, India ; D-6, Vishram Dham, Veena Nagar Phase II, Mulund (West), Mumbai, 80 India.
authors.forename: Pinky M
authors.initials: PM
authors.lastname: Thapar
authors.affiliation: Department of Minimal Invasive surgery, Critical Care, Radiology and Endoscopy, Jupiter Hospital, Thane Maharashtra, India.
authors.forename: Ravindra M
authors.initials: RM
authors.lastname: Ghawat
authors.affiliation: Department of Minimal Invasive surgery, Critical Care, Radiology and Endoscopy, Jupiter Hospital, Thane Maharashtra, India.
authors.forename: Abhay N
authors.initials: AN
authors.lastname: Dalvi
authors.affiliation: Department of Minimal Invasive surgery, Critical Care, Radiology and Endoscopy, Jupiter Hospital, Thane Maharashtra, India.
authors.forename: Muktachand L
authors.initials: ML
authors.lastname: Rokade
authors.affiliation: Department of Minimal Invasive surgery, Critical Care, Radiology and Endoscopy, Jupiter Hospital, Thane Maharashtra, India.
authors.forename: Roji M
authors.initials: RM
authors.lastname: Philip
authors.affiliation: Department of Minimal Invasive surgery, Critical Care, Radiology and Endoscopy, Jupiter Hospital, Thane Maharashtra, India.
authors.forename: Gireesh M
authors.initials: GM
authors.lastname: Warawdekar
authors.affiliation: Department of Minimal Invasive surgery, Critical Care, Radiology and Endoscopy, Jupiter Hospital, Thane Maharashtra, India.
authors.forename: Mukta R
authors.initials: MR
authors.lastname: Bapat
keywords: Angiographic embolization; Biliary fistula; Hepatic trauma; Laparoscopic lavage