Hepatic Compartment Syndrome Treated with Damage Control Surgery and Transarterial Embolization: A Case Report

2021 ◽  
Author(s):  
Motoo Fujita ◽  
Takeaki Sato ◽  
Kei takase ◽  
Tomomi Sato ◽  
Hajime Furukawa ◽  
...  
Keyword(s):  
Compartment Syndrome ◽  
Nonoperative Management ◽  
Damage Control ◽  
Transarterial Embolization ◽  
Damage Control Surgery ◽  
Surgical Decompression ◽  
Intraparenchymal Hemorrhage ◽  
Combination Strategy ◽  
Hemorrhage Control ◽  
Hepatocellular Damage

Abstract Background: Hepatic compartment syndrome (HCS) is a complication of nonoperative management in patients with blunt hepatic injury. Although decompression of elevated intrahepatic pressure through surgical exploration or drainage and hemorrhage control are required to manage this condition, evidence for such a management for this complication is insufficient. Herein, we report a pediatric patient treated with a planned combination strategy of surgical decompression with perihepatic packing to reduce intrahepatic pressure and subcapsular hemorrhage control as well as angioembolization to control intraparenchymal hemorrhage. Case presentation: A 12-year-old boy was referred to our emergency department 5 h after sustaining severe bruising in the upper abdomen in a traffic accident. Computed tomography (CT) showed an intraparenchymal hematoma in the right lobe of the liver; nonoperative management was selected based on stable hemodynamic status. Two days after the injury, he complained of severe abdominal pain and shock. CT showed an intraparenchymal and large subcapsular hematoma with right branch compression of the portal vein and extravasation of contrast material. Laboratory data showed progression of hepatocellular damage. We successfully managed this patient with a planned combination strategy of surgical decompression with perihepatic packing for reduction of intrahepatic pressure and subcapsular hemorrhage control, followed by angioembolization for control of intraparenchymal hemorrhage. Conclusion: Our study suggests that for the management of HCS, a planned combination strategy of damage control surgery and angioembolization is a therapeutic option.

Operative Exposure of Abdominal Injuries and Closure of the Abdomen

2019 ◽  
Author(s):  
Matthew D Nealeigh ◽  
Mark W Bowyer
Keyword(s):  
Open Abdomen ◽  
Nonoperative Management ◽  
Damage Control ◽  
Damage Control Surgery ◽  
Damage Control Resuscitation ◽  
Abdominal Injuries ◽  
Penetrating Injuries ◽  
Optimal Outcomes ◽  
Medial Rotation ◽  
Selective Nonoperative Management

Operative exposure and management of significant blunt or penetrating injuries to the abdomen is a critical skill required of all surgeons caring for victims of trauma. Application of damage control resuscitation and damage control surgical principles improves survival. Advances in diagnostics, increasing experience with selective nonoperative management, and use of endovascular and angiographic techniques have all significantly decreased the frequency of laparotomies performed for trauma. This decreasing clinical experience mandates that surgeons dealing with victims of trauma remain facile with the operative approaches and techniques detailed in this chapter to achieve optimal outcomes. Detailed management of specific injuries is covered in other chapters of this text. This review contains 7 figures, 2 tables, and 41 references.  Key Words: abdominal trauma, damage control resuscitation, damage control surgery, endovascular control of hemorrhage, open abdomen, REBOA, supraceliac control of aorta, trauma systems, visceral medial rotation

scholarly journals The Evolution of Damage Control in Concept and Practice

2017 ◽  
Vol 31 (01) ◽  
pp. 030-035 ◽  
Author(s):  
Brian Beldowicz
Keyword(s):  
Medical Decision Making ◽  
Damage Control ◽  
Damage Control Surgery ◽  
Strategy Implementation ◽  
Medical Decision ◽  
Metabolic Dysfunction ◽  
Damage Control Resuscitation ◽  
Hemorrhage Control ◽  
Threat To Life ◽  
Critically Ill Surgical Patients

AbstractDamage control surgery (DCS) began as an adjunct approach to hemorrhage control, seeking to facilitate the body's innate clotting ability when direct repair or ligation was impossible, but it has since become a valuable instrument for a broader collection of critically ill surgical patients in whom metabolic dysfunction is the more immediate threat to life than imminent exsanguination. Modern damage control is a strategy that combines the principles of DCS with those of damage control resuscitation. When used correctly, damage control may improve survival in previously unsalvageable patients; when used incorrectly, it can subject patients to imprudent risk and contribute to morbidity. This review discusses the evolution of damage control in both concept and practice, summarizing available literature and experience to guide patient selection, medical decision-making, and strategy implementation throughout the preoperative, intraoperative, and early postoperative periods.

Changes in Approach to Solid Organ Injury: What the Radiologist Needs to Know

2020 ◽  
Vol 71 (3) ◽  
pp. 352-361
Author(s):  
Siobhán B. O’Neill ◽  
Saira Hamid ◽  
Savvas Nicolaou ◽  
Sadia R. Qamar
Keyword(s):  
American Association ◽  
Nonoperative Management ◽  
Damage Control ◽  
Management Strategies ◽  
Damage Control Surgery ◽  
Organ Injury ◽  
Solid Organ ◽  
Imaging Findings ◽  
Solid Organ Injury ◽  
Imaging Protocols

This review aims to examine the challenges facing radiologists interpreting trauma computed tomography (CT) images in this era of a changing approach to management of solid organ trauma. After reviewing the pearls and pitfalls of CT imaging protocols for detection of traumatic solid organ injuries, we describe the key changes in the 2018 American Association for the Surgery of Trauma Organ Injury Scales for liver, spleen, and kidney and their implications for management strategies. We then focus on the important imaging findings in observed in patients who undergo nonoperative management and patients who are imaged post damage control surgery.

scholarly journals Severe Hepatic Trauma: Nonoperative Management, Definitive Repair, or Damage Control Surgery?

2011 ◽  
Vol 35 (12) ◽  
pp. 2643-2649 ◽  
Author(s):  
Ari K. Leppäniemi ◽  
Panu J. Mentula ◽  
Mari H. Streng ◽  
Mika P. Koivikko ◽  
Lauri E. Handolin
Keyword(s):  
Nonoperative Management ◽  
Damage Control ◽  
Damage Control Surgery ◽  
Hepatic Trauma ◽  
Definitive Repair

The abdominal compartment syndrome is a morbid complication of postinjury damage control surgery

2001 ◽  
Vol 182 (6) ◽  
pp. 542-546 ◽  
Author(s):  
Christopher D Raeburn ◽  
Ernest E Moore ◽  
Walter L Biffl ◽  
Jeffrey L Johnson ◽  
Daniel R Meldrum ◽  
...  
Keyword(s):  
Compartment Syndrome ◽  
Abdominal Compartment Syndrome ◽  
Damage Control ◽  
Damage Control Surgery ◽  
Abdominal Compartment

Chronic mesenteric ischaemia presenting as possible large bowl malignancy: an easily overlooked differential diagnosis

2021 ◽  
Vol 14 (3) ◽  
pp. e240202
Author(s):  
Benjamin McDonald
Keyword(s):  
Computed Tomography ◽  
Emergency Department ◽  
Weight Loss ◽  
Differential Diagnosis ◽  
Damage Control ◽  
Damage Control Surgery ◽  
Mesenteric Ischaemia ◽  
Abdominal Symptoms ◽  
Chronic Mesenteric Ischaemia ◽  
Descending Colon

An 80-year-old woman presented to a regional emergency department with postprandial pain, weight loss and diarrhoea for 2 months and a Computed Tomography (CT) report suggestive of descending colon malignancy. Subsequent investigations revealed the patient to have chronic mesenteric ischaemia (CMI) with associated bowel changes. She developed an acute-on-chronic ischaemia that required emergency transfer, damage control surgery and revascularisation. While the patient survived, this case highlights the importance of considering CMI in elderly patients with vague abdominal symptoms and early intervention to avoid potentially catastrophic outcomes.

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