Severe liver trauma in the face of coagulopathy. A case for temporary packing and early reexploration.

Most liver injuries lend themselves to satisfactory hemostasis and drainage, with or without resectional debridement. A small number of injuries will necessitate massive blood transfusion with clinically significant coagulopathy developing in about half of these patients despite prophylactic infusion of fresh frozen plasma and platelet concentrates. In our experience, after major, discrete arterial and venous vessels are individually ligated, the diffuse ooze from the raw surfaces can be effectively controlled by temporary packing of the liver. Packing provides time for coagulopathy and hypothermia to be corrected and for urgent diagnostic maneuvers to be completed safely. Packs should be removed early (within 24 to 48 hours postoperatively), and surgery performed as indicated by the injury. No intraabdominal abscesses have been encountered among our 12 patients who underwent temporary packing of their liver injuries.