MUMBAI, 14 JUNE, 2023 (GPN): A team led by Dr Imran Shaikh, Consultant GI & HPB Surgeon, Wockhardt Hospitals, Mira Road successfully treated a 25-year-old boy who met with an accident and suffered from massive liver injury with active bleeding. The patient with low blood pressure, received multiple blood transfusions, and underwent Perihepatic packing, a rare procedure done to control the liver bleeding.

Prajwal, a resident of Vasai, met with an accident. His bike skidded and collided against another bike and immediately a car ran over his abdomen. He was in terrible pain and became unconscious and was taken to a local hospital where the doctors tried to stabilize him. To his dismay, his blood pressure was dangerously low and the CT scan showed major liver injury with active bleeding. Hence, the patient was transferred to Wockhardt Hospitals, Mira Road in unstable condition.

Dr Imran Shaikh, Consultant GI & HPB Surgeon, Wockhardt Hospitals, Mira Road said, “On arrival in the emergency he had massive bleeding, the patient’s blood pressure wasn’t recordable, he was pale, and his pulse rate was 150 beats per minute, considering this he was in a near-death situation. He was given 4 bottles of blood to stabilize. Due to massive blood loss and shock, all his organs suffered including liver, heart, lung, kidney and needed life saving support. After counseling the family members, he was scheduled to undergo emergency surgery to control bleeding.  Before doing the surgery, a CT scan of liver was done which confirmed that 65% of right liver was completely damaged and was actively bleeding in the abdominal cavity and only 35% of his liver was functioning.

Dr. Imran added, “As soon as we opened the abdomen, a gush of blood came and his blood pressure could not be recorded again. Due to excessive loss of blood and clotting factors, his blood was very thin and not clotting. So, a DAMAGE CONTROL SURGERY was conducted in the form of PERIHEPATIC packing.

DAMAGE CONTROL SURGERY was originally described in the 2nd World War by German Doctors, this was a novel technique to control massive abdominal bleeding due to warfare injury and had saved lives of soldiers. It is a surgical procedure used in connection with trauma surgery to the liver. This rare procedure involves placing large mops all around the liver to compress it from all sides and pack the liver. Later, the bleeding stopped and the patient became stable and the blood pressure was normal. But, we didn’t close the abdomen due to the presence of mops inside.

Dr Monal Shah, Anesthesiologist added, “my main goal was to resuscitate this patient and maintain his vitals till Dr Imran can find the bleeder. The number one thing in a trauma patient is resuscitation to maintain perfusion and to prevent any further damage. The trauma triad also called the Triad of Death had set in by then, the only way to reverse this was to open and find the source and control the bleeding and simultaneously stabilize the patient. Without wasting much time and anticipating massive blood loss we called for blood; plasma and platelets and simultaneously wheeled in the patient since timing was another critical thing. There was intraoperatively waxing and waning of vitals, but due to availability of blood and blood products we could resuscitate. Intraoperatively patients lost 4 litres of blood which is equivalent to one blood volume for the human body which was replaced by blood and blood products and fluids. Patient being young could tolerate the blood loss and as soon as packing was done the blood pressure started improving, by the end of the procedure we could resuscitate him and get him off the medicines required to maintain Blood Pressure.

The patient was then put on a ventilator electively and given multiple transfusions in the coming 3-4 days which includes Blood, Fresh Frozen Plasma (FPP) and Cryoprecipitate to correct his coagulopathy and reverse the trauma related changes. After correcting deficiencies of coagulation the patient was planned for definitive surgery i.e Exploration Laparotomy sos resection of liver and mop removal. There was no active bleeding and BP was normal. Patient remained in the ICU on a ventilator for 2 days and then shifted to the ward for 7 days before discharge.”

“I had lost hope after my accident. But, I am happy that the doctors at Wockhardt Hospitals, Mira Road saved my life. I have no words to thank them. I am looking forward to recovering fully. I have indeed got a second lease of life,” concluded the patient.