L. M. Kodadek1, W. R. Leeper2, K. A. Stevens1, A. H. Haider3, D. T. Efron1, E. R. Haut1 1Johns Hopkins University School Of Medicine,Surgery,Baltimore, MD, USA 2Schulich School Of Medicine And Dentistry,Surgery,London, ONTARIO, Canada 3Brigham And Women’s Hospital,Center For Surgery And Public Health,Boston, MA, USA
Introduction:
Severe penetrating liver injuries are associated with high rates of morbidity and mortality. The objective of this study was to demonstrate the experience of a single urban, Level 1 trauma center with use of intrahepatic balloon tamponade for penetrating liver injuries.
Methods:
This retrospective study queried the trauma registry for patients age 16 and older with traumatic liver injury (ICD-9 864.00-864.19) from penetrating injury undergoing exploratory laparotomy (procedure code 54.11, 54.12, 54.19) from 2000 through 2015. Operative notes were used to identify cases employing intrahepatic balloon tamponade. Charts were reviewed for patient characteristics, injury characteristics, morbidity, and in-hospital mortality.
Results:
Of the 4,961 penetrating trauma patients admitted during the study period, 279 (5.6%) had liver injury and underwent exploratory laparotomy. Intrahepatic balloon tamponade was attempted in 9 patients (3.2%) for liver injury secondary to gunshot (8 patients) or stab wounds (1 patient). Seven cases (77.8%) utilized a penrose drain/red rubber catheter balloon and two cases utilized foley catheter balloon. One patient had the balloon immediately removed for increased hemorrhage after placement. Two of the 9 patients (22%) were in arrest at time of balloon placement and died during the index operation; both had retrohepatic IVC injury combined with cardiopulmonary injury. Among the 7 survivors, 2 had biliary injury requiring stent, 3 required hepatic angioembolization for definitive hemorrhage control, and 2 developed liver abscess. One patient, temporized with balloon tamponade, ultimately required left hepatectomy.
Conclusion:
Although rarely needed, trauma surgeons must be prepared to use intrahepatic balloon tamponade as one surgical technique to control major hepatic injuries. This procedure can result in survival even after major penetrating liver injury.
