Complete dissection of a hepatic segment after blunt abdominal injury successfully treated by anatomical hepatic lobectomy: report of a case

Abstract

A 21-year-old male patient was transferred to the emergency room of our hospital after suffering seat belt abdominal injury in a traffic accident. Abdominal computed tomography revealed a massive hematoma in the abdominal cavity associated with deep hepatic lacerations in the right lobe. The presence of a solid tissue possibly containing pneumobilia was observed above the greater omentum. These findings were consistent with a tentative diagnosis of hepatic laceration due to blunt trauma; therefore, this prompted us to perform emergency laparotomy. The operative findings revealed a massive hematoma and pulsatile bleeding from the lacerated liver and a retroperitoneal hepatoma, which was most likely due to subcapsular injury of the right kidney. In accordance with the preoperative imaging studies, a pale liver fragment on the greater omentum was observed, which was morphologically consistent with the defect in the posterior segment of the liver. Since the damaged area of the liver broadly followed the course of the middle hepatic vein, we carefully inspected and isolated the inflow vessels and eventually performed a right hepatic lobectomy. The patient's postoperative course was uneventful, and he was doing well at 10 months after surgery.

Keywords: Dissected liver tissue; Liver laceration; Surgical resection.

Fig. 1

Abdominal CT scans 6 h after injury. a As found at the time of injury, the concentration in the area with a poorly defined border in the anterior segment had decreased slightly and the area was becoming distinct. b Below the kidney, a flat parenchymal structure was present, the interior of which contained vasculature with a low concentration and vasiform gases, and the structure was believed to be a torn liver parenchyma. c Magnification of the area believed to be a torn liver parenchyma.

Fig. 2

Surgical findings. a A deep liver injury was observed from the posterior to the anterior segment, and as in the CT findings, there was a deficit in a portion of the posterior segment. b The vascular channel was treated anatomically. c Resection stump after right hepatic lobectomy.

Fig. 3

Resected specimen. The defective liver tissue was drained of blood and was pale. Moreover, the extracted defective portion and the resected liver were combined and were consistent with part of the posterior segment.

Fig. 4

Postoperative course. The circulatory dynamics were stabilized through the rapid administration of intravenous fluids at the time of hospitalization, and emergency surgery was performed based on the results of the examinations. The clinical course was good, and the patient was discharged from the intensive care unit on postoperative day 4. There were no particular complications, and the patient was discharged from the hospital on postoperative day 17.