Right Hemihepatectomy after Damage control Surgery for High-grade Hepatic Injury with Diaphragm Rupture

Abstract

A 40-year-old male was admitted with penetrating and blunt injury to his right thoracoabdominal area caused by a crushing accident at his workplace (Fig. 1.). Upon admission, he was alert with a blood pressure of 135/81 mm Hg, pulse rate of 109 beats/min, respiratory rate of 40/min, and hemoglobin level of 8.5 g/dL. Physical examination revealed peritoneal irritation signs on the whole abdomen. A focused assessment with sonography for trauma revealed large amounts of intra-abdominal fluid collection in the Morison pouch and splenorenal recess. Computed tomography performed in response to resuscitation demonstrated a right hepatic injury and a right diaphragm rupture with herniation of the colon (Fig. 2.). He underwent emergency laparotomy, including primary repair of the right diaphragm, perihepatic packing, and temporary abdominal closure, with an operation time of 84 min (Video 1.). After the damage control surgery, a lethal triad with a pH of 7.26, lactate level of 4.3 mmol/L, international normalized ratio of 2.40, and a temperature of 35.1°C occurred and was corrected after resuscitation of transfusion and warming in the intensive care unit (ICU). Definitive surgery, including right hemihepatectomy and definitive abdominal closure, was performed 12 h after the first operation (Video 2.). The patient was discharged without any complications 20 days after the definitive surgery.