Soma Jun, Ishii Daisuke, Miyagi Hisayuki, Ishii Seiya, Motoki Keita, Kawabata Hidemasa, Ishitoya Shunta, Hagiwara Masahiro, Kokita Naohiro, Hirasawa Masatoshi
Division of Pediatric Surgery, Department of Surgery, Asahikawa Medical University, 2-1-1, Midorigaokahigashi, Asahikawashi, Hokkaido, 078-8510, Japan.
Division of Gastroenterology and Hematology/Oncology, Department of Medicine, Asahikawa Medical University, 2-1-1, Midorigaokahigashi, Asahikawashi, Hokkaido, 078-8510, Japan.
Surg Case Rep. 2021 Dec 20;7(1):269. doi: 10.1186/s40792-021-01348-8.
Intra-abdominal hemorrhage caused by blunt hepatic injury is a major cause of morbidity and mortality in patients with abdominal trauma. Some of these patients require laparotomy, and rapid decision-making and life-saving surgery are essential. Damage control (DC) surgery is useful for treating children in critical situations. We performed this technique to treat an 8-year-old boy with grade IV blunt hepatic injury and multiple organ damage. This is the first report of the use of the ABTHERA Open Abdomen Negative Pressure Therapy System (KCI, now part of 3 M Company, San Antonio, TX, USA) for DC surgery to rescue a patient without neurological sequelae.
An 8-year-old boy was brought to the emergency department of our hospital after being run over by a motor vehicle. He had grade IV blunt hepatic injury, thyroid injury, and bilateral hemopneumothorax. Although he was hemodynamically stable, the patient's altered level of consciousness, the presence of a sign of peritoneal irritation, and suspicion of intestinal injury led us to perform exploratory laparotomy. As part of a DC strategy, we performed gauze packing to control hemorrhage from the liver and covered the abdomen with an ABTHERA Open Abdomen Negative Pressure Therapy System to improve the patient's general condition. Eighteen days after admission, the patient was diagnosed with a biliary fistula, which improved with percutaneous and external drainage. He had no neurological sequelae and was discharged 102 days after injury.
The DC strategy was effective in children with severe blunt hepatic injury. We opted to perform DC surgery because children have less hemodynamic reserve than adults, and we believe that using this strategy before the appearance of trauma triad of death could save lives and improve outcomes. During conservative management, it is important to adopt a multistage, flexible approach to achieve a good outcome.
钝性肝损伤所致腹腔内出血是腹部创伤患者发病和死亡的主要原因。其中一些患者需要进行剖腹手术，快速决策和挽救生命的手术至关重要。损伤控制（DC）手术对于治疗处于危急状况的儿童很有用。我们采用该技术治疗一名患有IV级钝性肝损伤和多器官损伤的8岁男孩。这是首次报道使用ABTHERA开放式腹腔负压治疗系统（KCI，现属美国德克萨斯州圣安东尼奥市3M公司）进行DC手术以挽救一名无神经后遗症的患者。
一名8岁男孩在被机动车碾压后被送至我院急诊科。他患有IV级钝性肝损伤、甲状腺损伤和双侧血气胸。尽管他血流动力学稳定，但患者意识水平改变、存在腹膜刺激征以及怀疑有肠损伤，这促使我们进行了剖腹探查术。作为DC策略的一部分，我们进行了纱布填塞以控制肝脏出血，并用ABTHERA开放式腹腔负压治疗系统覆盖腹部以改善患者的一般状况。入院18天后，患者被诊断为胆瘘，经经皮引流和外部引流后病情好转。他没有神经后遗症，受伤102天后出院。
DC策略对严重钝性肝损伤儿童有效。我们选择进行DC手术是因为儿童的血流动力学储备比成人少，并且我们认为在死亡三联征出现之前采用该策略可以挽救生命并改善预后。在保守治疗期间，采用多阶段、灵活的方法以取得良好结局很重要。
