Perihepatic Packing: A Life Saving Procedure in Liver Trauma

Abstract

Objective: Liver is one of the most common organ injured in Blunt and penetrating abdominal trauma and is the 2nd most common cause of mortality in these patients. The main objective of this study is to analyse the role and success rate of perihepatic packing in liver trauma Materials & Methods: This is a prospective study conducted on 200 patients of Liver trauma admitted in a tertiary care hospital over 2 year period with 3 months postoperative followup. Most of the High Grade liver injuries with uncontrolled venous bleeding were subjected to perihepatic Packing. The patient were shifted to ICU postoperatively and reexplored after 48 hours for pack removal. Results: 30 patients were subjected to Perihepatic packing with success rate of 80% in achieving haemostasis.24 cases were due to blunt while 6 due to penetrating trauma. Commonly seen in younger age group with male dominance. Majority of the injuries were AAST Grade III and IV type. Discussion: In Liver trauma the prime goal is Life Saving by control of Haemorrhage. Various advanced procedures are performed for the same, however it may not be possible to carry out all these in an emergency setting of Haemodynamically unstable patients. In these selected cases, Perihepatic packing is the Gold standard to achieve haemostasis as damage control or Definitive procedure. Conclusion: Perihepatic Packing is a highly recommended procedure in selected cases of High Grade liver injuries mainly for control of venous bleeding. Good postoperative ICU ventilator support under Broad spectrum Antibiotic cover is mandatory to minimize morbidity and mortality associated with the procedure. Keywords: Liver trauma, Perihepatic Packing, Blunt abdominal trauma, Reexploration.