American journal of surgery
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Early intra-abdominal packing is a lifesaving maneuver for selected patients with major liver injuries. However, the effectiveness of perihepatic packing can be limited by renewed bleeding when laparotomy pads that have become adherent to the injured liver surface are removed. A technique for intra-abdominal packing of complex liver injuries is presented that avoids the bleeding sequelae related to pack removal.
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This study was undertaken to evaluate the clinical significance of periportal tracking on computed tomography (CT) in patients with blunt liver trauma. The clinical records and CT findings of 88 patients were reviewed. Angiographic study revealed potential injury to portal triads in patients with periportal tracking on CT. ⋯ Hepatic complications such as bile leak, biloma, hemobilia, and infected hematoma were evaluated separately in 43 patients treated conservatively and 45 patients treated surgically. The incidence of complications in patients with periportal tracking was significantly higher in both groups (nonoperative; P < 0.01, chi-square = 8.46 and operative; P < 0.01, chi-square = 8.48). We conclude that periportal tracking on CT implies injury to the subhepatic region and intrahepatic portal triads and that it requires careful examination for extrahepatic injuries in the initial management and late hepatic complications in the follow-up management.