ISSN 1308-8734 | E-ISSN 1308-8742
Case Report
Management of Resistant Cardiac Depression after Hepatic Trauma Controlled with a Packing Procedure
1 Ege University, Faculty of Medicine, Department of General Surgery, Izmir, Turkey  
2 Ege University, Faculty of Medicine, Department of Anesthesiology, Izmir, Turkey  
Eurasian J Med 2009; 41: 66-69

Key Words: Hepatic trauma, Perihepatic packing, Cardiac depression, Earlier reoperation
Abstract

 

In addition to hemorrhage, which is one of the most wellknown factors, there are many other causative factors for serious hypotension after hepatic trauma. In this report, we present patients with persistent cardiac depression after perihepatic packing due to high grade liver injury and report on treatment modalities, including the early second-look procedure. Three patients with isolated hepatic trauma were included. Two of the patients who underwent perihepatic packing were transferred from outside hospitals, and one patient required repacking due to severe hemorrhage. All patients had grade IV injuries due to blunt (n=2) or penetrating injury (n=1). In the intensive care unit, central venous pressure (8, 12, 13 mmHg) and hematocrit (26, 27, 29%) were in the normal range, but blood pressure (40/60, 50/70, 45/75mmHg) was abnormal despite the use of inotropic support. The three patients underwent an unpacking procedure 8, 10, and 14 hours later, respectively. Inotropic support was not required after postoperative hours 3, 5, and 6, respectively.

 

The management of post reperfusion syndrome due to hepatic trauma can be achieved, but close collaboration between the surgeon and anesthesiologist is absolutely necessary. In the case of resistance cardiac depression in patients with packing, second-look procedures should be performed as early as possible.

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