Management of severe blunt liver injuries by applying the damage control strategies with packing-oriented surgery: experiences at a single institution in Korea.
OBJECTIVE
This study was conducted to investigate effective management strategies for patients with severe blunt liver injuries.


METHODS
Treatment methods and outcomes of 77 patients with grade IV-V damage among patients with liver injury managed between 2009 and 2013 were investigated.


RESULTS
Of the 77 patients, 32 were managed surgically. Packing was performed in 29 of these patients, while 26 also underwent liver surgery to maximize the hemostatic effect of packing. All 32 underwent temporary abdominal closure, and the mean amount of blood products used in the first 24 hours after admission included packed red blood cell, 13.3 units; fresh frozen plasma, 12.4 units; and platelets, 12.2 units, very close to 1:1:1. A total of 9 of 77 (11.7%) patients and 8 of 32 who underwent the operation died (operative mortality rate, 25%). Liver-related uncontrolled hemorrhage contributing to death occurred in four patients (12.5%).


CONCLUSIONS
Although nonoperative management can first be pursued if the patient's condition allows for it, hemodynamic instability and evidence of peritonitis requires surgical management. Surgical management should abide by the damage control surgery principles that focus on packing to minimize surgical time, followed by aggressive critical care according to damage control resuscitation.
Kyoungwon
K
Jung
Younghwan
Y
Kim
Yunjung
Y
Heo
John Cook-Jong
JC
Lee
SeokHwa
S
Youn
Jonghwan
J
Moon
Jiyoung
J
Kim
Tea-Youn
TY
Kim
Bongwan
B
Kim
Heejung
H
Wang
D000007:Abdominal Injuries / Q000175:diagnosis / Q000209:etiology / Q000401:mortality / Q000503:physiopathology / Q000601:surgery*; D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001803:Blood Transfusion; D002648:Child; D002675:Child, Preschool; D005260:Female; D006439:Hemodynamics; D006470:Hemorrhage / Q000175:diagnosis / Q000209:etiology / Q000401:mortality / Q000503:physiopathology / Q000601:surgery*; D006489:Hemostatic Techniques / Q000009:adverse effects / Q000401:mortality; D006490:Hemostatics / Q000627:therapeutic use; D006498:Hepatectomy / Q000009:adverse effects / Q000401:mortality; D017052:Hospital Mortality; D006801:Humans; D015601:Injury Severity Score; D008099:Liver / Q000098:blood supply / Q000293:injuries* / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D010538:Peritonitis / Q000209:etiology / Q000601:surgery; D056910:Republic of Korea; D012307:Risk Factors; D013536:Suture Techniques; D013997:Time Factors; D014014:Tissue Adhesives / Q000627:therapeutic use; D016896:Treatment Outcome; D014949:Wounds, Nonpenetrating / Q000175:diagnosis / Q000209:etiology / Q000401:mortality / Q000503:physiopathology / Q000601:surgery*; D055815:Young Adult
D006490:Hemostatics; D014014:Tissue Adhesives