Blunt Liver Trauma: Significant Hepatic Bleeding Persisting After Perihepatic Packing

This protocol applies when major hepatic hemorrhage continues despite initial surgical management — a pattern that signals a more proximal vascular injury requiring a different operative strategy.

Clinical Scenario

Significant bleeding persists after a Pringle maneuver, raising the suspicion of juxtahepatic venous injury to the retrohepatic vena cava or major hepatic veins.

Prior Treatment — Hemostasis Not Achieved

Perihepatic packing (omental and/or gauze packing, avoiding direct repair) was the initial intervention. When this approach fails to achieve control of hepatic bleeding, escalation is required.

Next Step — Vascular Control

The approach at this stage centers on vascular isolation with a shunting procedure aimed at achieving definitive hemostasis. The complete structured protocol — covering the full range of surgical options and their sequencing — is available below.

Instant Access to Structured Evidence-Based Regimens

References

If significant bleeding persists after a Pringle maneuver, juxtahepatic venous injury to the retrohepatic vena cava or major hepatic veins must be suspected.
Isolation entails control of the hepatic artery and portal vein by a Pringle maneuver, control of the subhepatic, suprarenal cava, and control of the suprahepatic cava.

DOI: 10.1097/TA.0b013e318220b192

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