Pedicled Tubular Omental Patch for Tamponade of Transfixing Gunshot Bilobar Liver Injury: A Case Report

Abstract

Introduction: Liver injuries are frequent in abdominal trauma and may be managed using a variety of methods. The operative management of deep, penetrating wounds generally involves balloon tamponade of the wound tract using a Sengstaken-Blakemore catheter. Case Presentation: A haemodynamically unstable 34-year-old male with multiple thoracoabdominal gunshot wounds was transferred to the operating theatre. At laparotomy, a grade 3 transfixing (through and through) bilobar hepatic wound was discovered with active hemorrhage. Unfortunately, no suitable balloon catheters were available, so, as an alternative, tamponade of the wound tract was successfully achieved using a tubular omental patch. Discussion: Omental patches are commonly used in the management of perforated duodenal ulcers and have been used to prevent recurrence following hepatic cyst de-roofing. To the authors’ knowledge, this is the first description of this technique for the management of penetrating bilobar transfixing hepatic injury. Conclusion: A tubular omental patch may be used to achieve tamponade of deep wounds in penetrating hepatic trauma. This could be a particularly useful technique in resource-poor environments, or where a suitable balloon catheter is otherwise unavailable.