Content area
Full Text
A 25-year-old man was found down on the roadside after an assault. After a semilucid interval, he became progressively agitated. On arrival to the trauma bay, his heart rate was 141 beats/min and his blood pressure was 134/104 mmHg. He was intubated because of his altered mental status. A small abrasion on his right temple was the only external sign of trauma. The abdominal examination was benign. Head computed tomography (CT) was negative. Abdominal CT revealed a bleeding 13 . 9 . 12-cm cavernous hepatic hemangioma with massive hemoperitoneum (Figs. 1 and 2).
Embolization of the tumor's feeding vessel was performed by interventional radiology (Fig. 3). After the procedure, the patient developed abdominal compartment syndrome and he was taken emergently to the operating room. On laparotomy, 6 L of blood was evacuated and retransfused. The tumor was deeply lacerated but nearly hemostatic. The origin was a well-defined pedicle projecting from the anteroinferior edge of the right liver. This was divided using a GIA stapler (Fig. 4). Electrocautery and liver sutures were used to control scant residual bleeding along the liver edge. As a result of hemodynamic instability, a damage control approach with a temporary abdominal closure was selected. The patient was taken to the intensive care unit for correction of his coagulopathy, warming, and further resuscitation.
A staged abdominal closure was performed over 6 days using a Whitman patch and eventually a biologic mesh underlay....