Saving a female patient who suffered a ruptured liver accident while riding a motorbike home

On February 19, information from Can Tho Central General Hospital said that doctors had just saved a traffic accident victim with a critical liver rupture using endovascular intervention techniques.

Previously, female patient HTH (45 years old, living in Bac Lieu province) was riding a motorbike from Binh Duong to her hometown for Tet when she had a traffic accident and was taken to a local hospital for emergency treatment.

After surgery to suture the liver and insert a hemostatic gauze pad, the patient was transferred to Can Tho Central General Hospital in critical condition, with a balloon pump through the endotracheal tube...

After hemostatic intervention and emergency surgery, the patient was saved.

Immediately after admission, the patient was treated by the Emergency Department for traumatic shock with blood transfusion, rapid fluid infusion, mechanical ventilation... The CT scan results showed that the patient had grade 3-4 liver trauma, with a vascular escape, hematoma around the liver and hypogastric region, fractures of the 4th and 5th ribs on the right side, and right pleural effusion... Through consultation, the doctors determined that the patient was in shock and had a blood clotting disorder, so the optimal choice was to take an ultrasound and digital subtraction angiography.

The team led by Dr. Tran Cong Khanh, Deputy Head of the Department of Diagnostic Imaging, performed the intervention for the patient. The results recorded a leak from the right hepatic artery branch, and simultaneously pumped the embolism with a glue mixture. The procedure lasted about 40 minutes, after which the patient continued to receive surgical resuscitation, mechanical ventilation, fluid replacement, blood replacement, antibiotics, pain relief, and electrolyte balance.

The patient's liver ruptured extravasation status before intervention

After the patient's general condition stabilized, the doctors of the Department of Thoracic and Vascular Surgery continued to perform surgery to drain about 500 ml of blood from the pleura. The Department of General Surgery also performed surgery to remove abdominal swabs and treat associated injuries.

During the emergency and surgery at Can Tho Central General Hospital, the patient was transfused with 15 units of blood and blood products. Currently, the patient is conscious, with pink skin and mucous membranes, a dry surgical wound, and a soft abdomen.

After intervention, the patient's liver no longer had a leak.

According to Dr. Truong Thanh Son, Department of General Surgery, Can Tho Central General Hospital, the liver is a large solid organ in the body, especially the liver contains many blood vessels. Therefore, a ruptured liver can easily lead to rapid blood loss, endangering the patient's life.

Liver rupture in closed abdominal trauma is very complicated, requiring correct diagnosis and timely treatment, especially in the case of multiple trauma. Suturing or cutting the damaged liver to stop bleeding is a radical hemostatic measure. However, in cases of grade 4, 5 liver rupture, the rupture is complex, the damaged liver is large, it is very difficult to suture or cut the liver, accompanied by massive bleeding, severe shock, multiple trauma, blood clotting disorders... Therefore, the choice of endovascular intervention and surgery can be applied separately or in combination to bring about optimal treatment results. With the method of embolization of the hemostatic vessels (no anesthesia), as in the case of the above patient, the damaged internal organs will be maximally preserved, the patient does not have to undergo heavy major surgeries lasting for hours, with potential complications during and after surgery such as hemorrhagic shock, surgical site infection...

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