Surgical treatment of combined thoraco-abdominal injury of liver with the mechanism of the hydrodynamic shock (case report)

Authors

  • Ievgen Tsema National Military Medical Clinical Center of Ministry of Defense of Ukraine, Ukraine (Kyiv), Bogomolets National Medical University of Ministry of Health of Ukraine, Ukraine (Kyiv) http://orcid.org/0000-0002-1178-7529
  • Igor Khomenko National Military Medical Clinical Center of Ministry of Defense of Ukraine, Ukraine (Kyiv)
  • Vitalii Shapovalov Military Medical Clinical Center of South Region of Ministry of Defense of Ukraine (Odesa)
  • Georgii Makarov National Military Medical Clinical Center of Ministry of Defense of Ukraine, Ukraine (Kyiv)
  • Roman Palytsia National Military Medical Clinical Center of Ministry of Defense of Ukraine, Ukraine (Kyiv)
  • Andrii Dinets Bogomolets National Medical University of Ministry of Health of Ukraine (Kyiv)
  • Ievgen Zavodovskyi Bogomolets National Medical University of Ministry of Health of Ukraine (Kyiv)
  • Ivan Ishchenko National Military Medical Clinical Center of Ministry of Defense of Ukraine (Kyiv)

DOI:

https://doi.org/10.20883/jms.2017.227

Keywords:

a combined thoraco-abdominal injured, levels of the medical care, warfare on the East of Ukraine.

Abstract

This article presents a clinical case of successful multilevel treatment the combined gunshot wound of liver with the mechanism of hydrodynamic shock using «damage control» tactic. The patient received a combined thoraco-abdominal injured as a result of warfare on the east of Ukraine. The blind fragmental penetrating trauma of the chest cavity led to the rupture of the right dome of diaphragm and liver (S3–S6) by the mechanism of hydrodynamic kick (fragments the wreckage and input/output openings in the abdominal cavity were not found). The «damage control» tactic was implemented as follows. On the second level of medical care the rupture of the liver parenchyma eliminated by repeated firmwares with omentopexy. The post-traumatic period proceeded with the several consecutive complications: cutting the liver sutures, the arrosive bleeding from the right hepatic artery and the irreversible ischemia of the liver S5-S6. These complications were liquidated gradually on the IV level of medical care by the transpupillary choledochal stenting, vascular suture and the imposition of a typical anatomical resection of liver S5–6. Successful treatment of patients with the severe fragmental gunshot thoraco-abdominal injuries should be based on a clear understanding of the stages of traumatic disease and expected complications of parallel conduct medical evacuation, using «damage control» tactic on the all levels of medical care.

Downloads

Download data is not yet available.

Author Biographies

Ievgen Tsema, National Military Medical Clinical Center of Ministry of Defense of Ukraine, Ukraine (Kyiv), Bogomolets National Medical University of Ministry of Health of Ukraine, Ukraine (Kyiv)

Abdominal sudgery. professor

Igor Khomenko, National Military Medical Clinical Center of Ministry of Defense of Ukraine, Ukraine (Kyiv)

Abdominal sudgery. professor

Vitalii Shapovalov, Military Medical Clinical Center of South Region of Ministry of Defense of Ukraine (Odesa)

Abdominal sudgery, MD

Georgii Makarov, National Military Medical Clinical Center of Ministry of Defense of Ukraine, Ukraine (Kyiv)

Abdominal sudgery, MD

Roman Palytsia, National Military Medical Clinical Center of Ministry of Defense of Ukraine, Ukraine (Kyiv)

surgeon-hepathologist, MD

Andrii Dinets, Bogomolets National Medical University of Ministry of Health of Ukraine (Kyiv)

Abdominal sudgery, PhD

Ievgen Zavodovskyi, Bogomolets National Medical University of Ministry of Health of Ukraine (Kyiv)

Abdominal sudgery, PhD

Ivan Ishchenko, National Military Medical Clinical Center of Ministry of Defense of Ukraine (Kyiv)

Abdominal sudgery, MD

References

Akkucuk S, Aydogan A, Yetim I, et al. Surgical outcomes of a civil war in a neighbouring country. J R Army Med Corps. 2016;162(4):256–260.

Bodalal Z, Mansor S. Gunshot injuries in Benghazi-Libya in 2011: the Libyan conflict and beyond. Surgeon. 2013;11(5):258–263.

Holt E. Health care collapsing amid fighting in east Ukraine. Lancet. 2015;385(7):494.

Khmehl VV, Mayetniy EM, Levshov YA.The treatment of injured persons with complicated penetrating thoracic woundings on tertiary level of the medical care delivery. Klin Khir. 2016;1:47–49.

Rozin YA, Ivanenko AA. Early specialized surgical care for gunshot wounds of major vessels in Donbas. Angiol Sosud Khir. 2016;22(2):156–160.

Schoenfeld AJ, Dunn JC, Bader JO, Belmont PJ Jr. The nature and extent of war injuries sustained by combat specialty personnel killed and wounded in Afghanistan and Iraq, 2003- 2011. J Trauma Acute Care Surg. 2013;75(2):287–291.

Schwartz D, Glassberg E, Nadler R, et al. Injury patterns of soldiers in the second Lebanon war. J Trauma Acute Care Surg. 2014;76(1):160–166.

Tsema Ie, Bespalenko A. Analysis of limb amputations during armed conflict at the East of Ukraine. Norwegian Journal of development of the International Science. 2016;1:79–80.

Valentine KP. Bacterial flora of combat wounds from Eastern Ukraine and time-specified changes of bacterial recovery during treatment in Ukrainian military hospital. BMC Res Notes. 2017;10(7):152.

Downloads

Published

2017-09-30

How to Cite

1.
Tsema I, Khomenko I, Shapovalov V, Makarov G, Palytsia R, Dinets A, et al. Surgical treatment of combined thoraco-abdominal injury of liver with the mechanism of the hydrodynamic shock (case report). JMS [Internet]. 2017 Sep. 30 [cited 2024 Mar. 28];86(3):240-4. Available from: https://jms.ump.edu.pl/index.php/JMS/article/view/227

Issue

Section

Case Study
Received 2017-04-28
Accepted 2018-01-29
Published 2017-09-30