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

  • 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)
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.