Mesh-wrapping for the treatment of fractured liver-A case report.
BACKGROUND
Major liver trauma is a potentially fatal injury. Management of liver injuries has considerably changed over the past decades with a trend towards a multidisciplinary approach. Most liver injuries can be managed conservatively; however, some cases need operative management.


METHODS
We present a case of a 73year old female who underwent laparoscopic cholecystectomy that was complicated by a life-threatening liver fracture and was successfully managed by staged laparotomies and liver mesh-wrapping.


CONCLUSIONS
Mesh wrapping is an effective approach for achieving hemostasis by a temponading effect. An alternative to liver packing would be the resection of the affected segmented, however this should be assessed based on the extent of the injury as well as on the hemodynamic stability of the patient who, in majority, are hemodynamically compromised. The advantage however of liver wrapping is that there is no need for reoperation to remove the mesh, the hazard of re-bleeding is diminished because the mesh is left in place, and the incidence of septic complications is low. In this case, the mesh was sutured to the diaphragmatic crus as well as to the falciform ligament to secure the mesh on two anchoring points.


CONCLUSIONS
Using an absorbable mesh on a traumatized and fragmented liver appears to be a safe and effective approach to high grade liver injury. The judicious use of cauterization, beaming or suturing to the liver bed to control oozing or bleeding should be advocated in order to avoid this highly morbid complication.
Department of General Surgery, American University of Beirut Medical Center, P.O. Box 11-0236, Beirut, Lebanon.
Ghassan
G
Chamseddine
Liver Transplantation and Hepatopancreaticobiliary Surgery, Department of General Surgery, American University of Beirut Medical Center, P.O. Box 11-0236, Beirut, Lebanon.
Mohamed
M
Khalifeh
Department of General Surgery, American University of Beirut Medical Center, P.O. Box 11-0236, Beirut, Lebanon.
Ghattas
G
Khoury
Department of General Surgery, American University of Beirut Medical Center, P.O. Box 11-0236, Beirut, Lebanon.
Jamal
J
Hoballah
Department of General Surgery, American University of Beirut Medical Center, P.O. Box 11-0236, Beirut, Lebanon.
Ghina
G
El Nounou
Faculty of Medicine, American University of Beirut Medical Center, P.O. Box 11-0236, Beirut, Lebanon.
Hussein
H
Nassar
Liver Transplantation and Hepatopancreaticobiliary Surgery, Department of General Surgery, American University of Beirut Medical Center, P.O. Box 11-0236, Beirut, Lebanon. Electronic address: wf07@aub.edu.lb.
Walid
W
Faraj
Bleeding; Case report; Liver fracture; Liver injury; Mesh