Damage Control in Penetrating Liver Trauma: Fear of the Unknown
Abstract
The liver is the most commonly affected solid organ in cases of abdominal trauma. Management of penetrating liver trauma is a challenge for surgeons but with the introduction of the concept of damage control surgery accompanied by significant technological advancements in radiologic imaging and endovascular techniques, the focus on treatment has changed significantly. The use of immediately accessible computed tomography as an integral tool for trauma evaluations for the precise staging of liver trauma has significantly increased the incidence of conservative non-operative management in hemodynamically stable trauma victims with liver injuries. However, complex liver injuries accompanied by hemodynamic instability are still associated with high mortality rates due to ongoing hemorrhage. The aim of this article is to perform an extensive review of the literature and to propose a management algorithm for hemodynamically unstable patients with penetrating liver injury, via an expert consensus. It is important to establish a multidisciplinary approach towards the management of patients with penetrating liver trauma and hemodynamic instability. The appropriate triage of these patients, the early activation of an institutional massive transfusion protocol, and the early control of hemorrhage are essential landmarks in lowering the overall mortality of these severely injured patients. To fear is to fear the unknown, and with the management algorithm proposed in this manuscript, we aim to shed light on the unknown regarding the management of the patient with a severely injured liver.
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Keywords
- REBOA
- REBOVC
- Penetrating Hemodynamically Unstable Liver Trauma.
- blood loss Surgical
- hospital emergency service
- algorithms
- laparotomy
- abdominal injuries
- liver
Author Biographies
, • Division of Trauma and Acute Care Surgery, Department of Surgery. Fundación Valle del Lili. Cali, Colombia. • Division of Trauma and Acute Care Surgery, Department of Surgery. Universidad del Valle, Cali, Colombia. • Universidad Icesi, Cali, Colombia.
https://orcid.org/0000-0003-4495-7405
, • Department of Trauma Critical Care, Broward General Level I Trauma Center, Fort Lauderdale, FL – USA
https://orcid.org/0000-0001-6496-6275
, • Universidad Icesi, Cali, Colombia. • Division of Transplant Surgery, Department of Surgery, Fundación Valle del Lili, Cali, Colombia
https://orcid.org/0000-0002-5502-5745
, • Centro de Investigaciones Clínicas (CIC), Fundación Valle del Lili, Cali, Colombia
https://orcid.org/0000-0002-6128-0128
, https://orcid.org/0000-0002-5515-263X
https://orcid.org/0000-0002-5515-263X
, • Centro de Investigaciones Clínicas (CIC), Fundación Valle del Lili, Cali, Colombia
, • Division of Trauma and Acute Care Surgery. Hospital Vicente Corral Moscoso, Cuenca, Ecuador. • Escuela de Medicina. Universidad del Azuay, Cuenca, Ecuador.
https://orcid.org/0000-0002-9084-3030
, • Division of Trauma and Acute Care Surgery, Department of Surgery. Fundación Valle del Lili. Cali, Colombia. • Division of Trauma and Acute Care Surgery, Department of Surgery. Universidad del Valle, Cali, Colombia. • Universidad Icesi, Cali, Colombia
, • Division of Trauma and Acute Care Surgery, Department of Surgery. Universidad del Valle, Cali, Colombia. • Division of Trauma and Acute Care Surgery, Department of Surgery. Hospital Universitario del Valle, Cali, Colombia. • Centro Médico Imbanaco, Cali, Colombia.
https://orcid.org/0000-0001-5862-4906
, • Division of Trauma and Acute Care Surgery, Department of Surgery. Universidad del Valle, Cali, Colombia. • Division of Trauma and Acute Care Surgery, Department of Surgery. Hospital Universitario del Valle, Cali, Colombia.
https://orcid.org/0000-0002-1179-2854
, • Division of Trauma and Acute Care Surgery, Department of Surgery. Universidad del Valle, Cali, Colombia. • Division of Trauma and Acute Care Surgery, Department of Surgery. Hospital Universitario del Valle, Cali, Colombia.
https://orcid.org/0000-0002-4526-7636
, Division of Trauma and Acute Care Surgery, Department of Surgery. Fundación Valle del Lili. Cali, Colombia
https://orcid.org/0000-0002-5326-2317
, • Division of Trauma and Acute Care Surgery, Department of Surgery. Fundación Valle del Lili. Cali, Colombia. • Division of Trauma and Acute Care Surgery, Department of Surgery. Universidad del Valle, Cali, Colombia. • Universidad Icesi, Cali, Colombia. • Division of Trauma and Acute Care Surgery, Department of Surgery. Hospital Universitario del Valle, Cali, Colombia.
https://orcid.org/0000-0001-9829-8930
, • Division of Trauma and Acute Care Surgery, Department of Surgery. Fundación Valle del Lili. Cali, Colombia. • Division of Trauma and Acute Care Surgery, Department of Surgery. Universidad del Valle, Cali, Colombia. • Universidad Icesi, Cali, Colombia. • Division of Trauma and Acute Care Surgery, Department of Surgery. Hospital Universitario del Valle, Cali, Colombia.
, 1. Brigham & Women’s Hospital, Department of Surgery, Center for Surgery and Public Health, Boston, USA 2. Harvard Medical School & Harvard T.H., Chan School of Public Health, Boston – USA
https://orcid.org/0000-0002-2249-9960
, Department of Surgery, University of Maryland School of Medicine, Baltimore, MD
, Professor Emeritus Virginia Commonwealth University, Richmond, VA, USA
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