Intraoperative use of recombinant activated factor VII in traumatic unpenetrating liver injury - case report

Abstract

Uncontrolled massive bleeding is often the cause of death of polytraumatized patients. Massive haemorrhage in polytrauma is the consequence of severe tissue and blood vessel damage or the development of posttraumatic coagulopathy. Most often, it is the combination of the two causes. Coagulopathy arises in early stages of trauma and it is an independent predictor of mortality of polytraumatized patients, however, its timely correction can significantly result in the reduction of mortality rate in trauma. We present a 15-year old male patient who fell from 11 m height and sustained injuries of the right lobe of liver, with partial avulsion and lacerations on the diaphragmal and visceral side of the right lobe. He also sustained brain injuries with presence of blood content in the right lateral chamber, numerous haemorrhagic spots and contusions in frontoparietal region and diffuse brain oedema of the right side of the hemisphere. A partial right sided hepatectomy was performed using the surgical techniques of haemostasis (ligation, tamponade, compression, embolisation), circulatory volume resuscitation (crystalloids and colloids), resuscitation of blood and blood components and the application of antifibrynolitics, as well as oxigenotherapy (endotracheal intubation and mechanical ventilation, with high inspiratory fractions of oxygen). Considering massive transfusions, the type and character of injury and visible oozing, as well as the fact that conventional methods did not stop the bleeding, recombinant activated factor VII (rFVIIa) was given intraoperatively, which resulted in successful reduction and finally the cecession of bleeding. Until today, there are numerous references about successful application of rFVIIa in uncontrolled bleedings in trauma when previously applied conventional methods of haemostasis were not sufficient. We are presenting a case of successful use of rFVIIa in our hospital accompanied by usual surgical measures and reanimation of a severely injured patient with massive bleeding. Based on our experience and available references, in case of timely diagnosis and adequate therapy, such as conventional treatment methods and the use of rFVIIa, uncontrolled bleedings in polytrauma have better prognosis.