A 28-year-old man sustains a gunshot wound to the abdomen with a through-and-through liver injury. During laparotomy, he develops hypothermia (34.5°C), metabolic acidosis (pH 7.18), and coagulopathy requiring massive transfusion. What is the most appropriate next step in management?
- A Complete definitive repair of all injuries and close the abdomen primarily
- B Pack the liver, perform temporary abdominal closure, and transfer to ICU for continued resuscitation ✓
- C Perform anatomic right hepatectomy and primary biliary reconstruction
- D Apply topical hemostatic agents only and observe in the operating room for 2 hours
Correct answer: B. Pack the liver, perform temporary abdominal closure, and transfer to ICU for continued resuscitation
Explanation
The patient exhibits the lethal triad of hypothermia, acidosis, and coagulopathy, which mandates damage control surgery. The correct approach is to control hemorrhage with packing, perform temporary abdominal closure, and transfer to the ICU for rewarming, correction of coagulopathy, and continued resuscitation before planned reoperation. Definitive repair in this setting would be fatal. Topical agents alone are insufficient for major liver injury.
Reference: Bailey and Love's Short Practice of Surgery, 27th ed.
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Written and medically reviewed by the StethoPrep medical team.