A Case of Successfully Treated Type IIIb Severe Liver Injury

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Severe liver injury is one of the most difficult lifesaving cases in the emergency room. We herein report on the successful treatment on a case of severe type IIIb liver injury with transcatheter arterial embolization (TAE).A 14-year-old boy was transferred to our emergency room by ambulance after a traffic accident in May 2003. His systolic blood pressure was 60 mmHg on arrival, but it rose up to 90 mmHg in response to fluid resuscitation. The patient underwent computed tomography, and a severe type IIIb liver injury was confirmed. TAE was first performed in this case. We were worried whether damage control surgery (DCS) was needed as a consecutive method because extravasations were detected from the right portal vein after the TAE. His condition demonstrated the deadly triad. However, because his bood pressure was maintained, conservative therapy in the intensive care unit, but not DCS, was selected as the post-TAE treatment. Drainage of bloody ascites was sometimes performed to prevent abdominal compartment syndrome under observation of the patient's intra-abdominal pressure and vital signs. In addition to one more TAE, two more surgical interventions, one for biliary peritonitis and the other for a small intestinal perforation, were required before the patient could be discharged. The period in hospital was approximately 10 months after the accident.