A 30-year-old man sustains a Grade V liver injury (AAST) from blunt abdominal trauma with hemodynamic instability. After initial damage control resuscitation in the ED with 2 units pRBC, he remains hypotensive (BP 80/50). The immediate operative priority is:
- A Perihepatic packing and temporary abdominal closure (damage control surgery) ✓
- B Formal right hepatectomy to control hemorrhage
- C Hepatic artery ligation
- D Angioembolization as first-line hemorrhage control
Explanation
Grade V liver injuries (juxtahepatic venous injuries involving retrohepatic vena cava or central hepatic veins) carry mortality >80%. The damage control surgery (DCS) principle dictates perihepatic packing to control hemorrhage, abbreviated laparotomy with temporary abdominal closure (Bogota bag or vacuum closure), followed by ICU resuscitation correcting the 'lethal triad' (hypothermia, coagulopathy, acidosis), and definitive repair in 24–48 hours when physiology is restored. Formal hepatectomy or vascular repair in a coagulopathic, hypothermic patient is lethal. Angioembolization is adjunctive after damage control packing.
Reference: Bailey & Love's Short Practice of Surgery, 27th ed.
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Written and medically reviewed by the StethoPrep medical team.