Major hepatic hemorrhage arising from a complex hepatic injury — one of the most challenging situations in trauma surgery, where persistent bleeding demands a structured escalation in management.
This protocol applies when the Pringle maneuver — vascular clamping at the porta hepatis, ligament takedown, ligation of bleeding vessels and injured bile ducts, resectional debridement of devascularized parenchyma, and omental packing — has failed to control hepatic bleeding. The clinical goal of hemostasis has not been reached, and a defined next step is required.
When bleeding persists despite those measures, a targeted intervention directed at the hepatic arterial supply is among the options available — with the preferred approach depending on clinical circumstances and available expertise.
Control of hepatic bleeding — achieving hemostasis.
The first step in the management of patients with major hepatic hemorrhage is manual compression.
If bleeding persists despite the above maneuvers, selective hepatic artery ligation can be considered by those experienced in the procedure.
Postoperative angioembolization is a better option when possible.
View source ↗