Intra-abdominal Packing for Control of Hepatic Hemorrhage

Abstract

Presently available techniques for control of hepatic hemorrhage in patients with extensive parenchymal injuries include direct suture, topical hemostatic agents, hepatotomy or resectional debridement with selective vascular ligation, lobectomy, and selective hepatic artery ligation. In many trauma centers the placement of intra-abdominal packing for hepatic tamponade was an infrequently used technique in recent years. From July 1, 1978-Sept. 1, 1980, 10 patients with continued hepatic parenchymal oozing following all attempts at surgical control of extensive injuries were treated by the insertion of intra-abdominal packing around the liver as a last desperate maneuver. Packing was removed at relaparotomy in 4 patients and through abdominal drain sites in 5 patients. Of 10 patients, 9 survived, and there were no instances of rebleeding following removal of the packing. Four patients developed postoperative perihepatic collections and 2 of the 4 patients underwent reoperation for drainage. Based on the recent experience at the Ben Taub General Hospital, Texas, USA, intra-abdominal packing for control of exsanguinating hepatic hemorrhage appears to be a lifesaving maneuver in highly selected patients in whom coagulopathies, hypothermia and acidosis make further surgical efforts likely to increase hemorrhage.