A 40-year-old man is stabbed in the right upper quadrant. FAST ultrasound is positive with free fluid. He is hemodynamically unstable. At laparotomy, a grade IV liver laceration (AAST) is found. The initial damage control surgical approach is:
- A Pringle maneuver followed by perihepatic packing and temporary abdominal closure ✓
- B Immediate hepatic lobectomy to control bleeding
- C Hepatic arterial embolization via interventional radiology
- D Direct suture repair of liver laceration with omental plugging
Explanation
AAST Grade IV liver laceration (parenchymal disruption 25-75% of hepatic lobe) in a hemodynamically unstable patient requires damage control surgery (DCS). The Pringle maneuver (clamping portal triad between thumb and forefinger through foramen of Winslow) temporarily reduces hepatic inflow, allowing perihepatic packing with laparotomy pads to achieve hemostasis. The abdomen is temporarily closed (vacuum-assisted or Bogota bag) and the patient transferred to ICU for correction of the lethal triad (hypothermia, coagulopathy, acidosis). Definitive repair or hepatectomy in a physiologically compromised patient is associated with very high mortality. IR embolization is for stable or stabilized patients.
Reference: Bailey & Love's Short Practice of Surgery, 27th ed.
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Written and medically reviewed by the StethoPrep medical team.