Journal of Emergencies, Trauma and Shock (Jan 2020)

Grade IV liver injury following mechanical cardiopulmonary resuscitation with postoperative three-dimensional evaluation

  • Paolo Aseni,
  • Federico Vezzulli,
  • Francesco Rizzetto,
  • Simone Cassin,
  • Sofia Rantas,
  • Alberto Cereda,
  • Osvaldo Chiara,
  • Angelo Vanzulli,
  • Maurizio Vertemati

DOI
https://doi.org/10.4103/JETS.JETS_28_20
Journal volume & issue
Vol. 13, no. 4
pp. 306 – 308

Abstract

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A 48-year-old female presented to the emergency department with chest pain and collapsed at the front desk. She was reanimated with mechanical chest compression, and after coronary angiography, a left anterior descending/diagonal bifurcation mini-crush stenting was performed. Few hours after the procedure, the patient showed severe hypotension. Abdominal ultrasound and computed tomography (CT) scan evidenced a massive subcapsular liver hematoma (Grade IV, American association for the surgery of trauma (AAST) liver injury scale) of the right lobe with extrahepatic blushing. Transhepatic embolization was attempted but without benefit, so the patient underwent emergency laparotomy for damage control surgery with perihepatic packing. After hemodynamic stabilization, right hepatectomy was performed with a favorable outcome and full recovery. The patient CT scan was retrospectively processed to obtain a virtual model visualizable through a head-mounted display. The virtual reconstruction could improve the comprehension of the injury and the liver surgical anatomy for educational purpose, and it could represent a new tool for preoperative planning.

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