Laparoscopic Approach to Severe Liver Injury in a Patient With Blunt Abdominal Trauma

With laparoscopic surgery becoming more popular in surgical practice, laparoscopic approaches in trauma patients have increased. Non-operative management is the standard treatment algorithm in patients with blunt abdominal trauma who are hemodynamically stable and have sustained a liver injury. However, laparoscopy is a safe and feasible method for exploration, irrigation, and treatment if a surgical intervention is needed in this group. In this study, we aimed to present a case of liver injury in blunt abdominal trauma and its management laparoscopically. A 22-year-old male was admitted to the Marmara University Hospital's Emergency Unit of a tertiary center following a truck accident. The patient was hemodynamically stable at admission. CT scan showed a grade IV liver laceration with hemoperitoneum. The patient was transferred to the observation room. After three hours, the patient's hemoglobin value decreased from 14.6 g/dl to 8.4 g/dl, and the mean arterial blood pressure decreased to 60 mmHg. The patient's heart rate increased to 125, and peritonitis was evident on the abdominal examination. Emergent laparoscopy was performed on the patient. Grade IV liver laceration with no active bleeding was observed. After peritoneal irrigation, surgery was terminated. With the developments in minimally invasive procedures, laparoscopic approaches were used more frequently in trauma patients. In the referral and experienced centers, laparoscopy could be an appropriate way to avoid unnecessary laparotomies.