The DAMAGE CONTROL technique applied in a child injured in a traffic accident after intraabdominal bleeding relapse

Abstract

EDITORIAL COMMENT. This clinical observation presents an effective application of elements of the abdominal damage-control tactics after postoperative intra-abdominal bleeding relapse under developed coagulopathy and previously underestimated liver damage during surgery. If an “unstable” patient with prolonged internal bleeding is admitted, it is recommended to apply this tactics in the primary surgical intervention with liver packing which would prevent postoperative bleeding and further development of coagulopathy. After patient’s hemodynamics is stabilized, it is necessary to make a complete patient’s examination so as to timely detect all associated injuries. Introduction. Closed trauma of abdominal organs in children in some cases is accompanied by severe complications or death. At the same time, liver injury occupies a leading place in the structure of the abovementioned pathology. Currently, in case of severe injuries of the abdominal organs accompanied by unstable hemodynamics and with a high risk of unfavorable outcomes after radical surgical intervention, surgeons prefer to apply the damage control technique in such patients. Material and methods. The authors discuss a case of successful management of a child injured in a traffic accident. He had multiple closed liver injuries of class III and hemorrhagic shock of degree 3. The DAMAGE CONTROL technique was applied during relaparotomy after intra- abdominal bleeding relapse developed. Results. In this given case, the damage control technique has promoted a successful outcome after staged surgical treatment without any complications in the immediate and late postoperative periods. Conclusion. In case of abdominal cavity trauma in children having hemorrhagic shock and prolonged bleeding from liver wounds, the damage control technique promotes stabilization of patient’s state, arrests bleeding and gives precious time to finish surgical intervention in more favorable situation for both patients and surgeons.