Non-operative management of hemodynamically stable grade V l
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A 50-year-old male was the restrained passenger involved in high-energy car crash on the highway. He was hypotensive in the emergency room (blood pressure [BP] 80/60 mmHg). Fluid resuscitation was initiated with reasonable improvement of Blood Pressure and Heart Rate and maintenance of hemodynamic stability thereafter. Contrast-enhanced computed tomography showed a large liver hematoma occupying a greater portion of the right lobe, with minimal amount of peritoneal free fluid, an active arterial blush and a large hematoma extending vertically, all around the Inferior Vena Cava in its retrohepatic tract, consistent with a contained venous bleeding from hepatic veins injury (American Association for the Surgery of Trauma grade V). The patient was kept under permissive hypotension and cautious fluid resuscitation, showing a transient response throughout the next hour. Urgent angioembolization was performed achieving the closure of the arterial bleeding with coils. Hemodynamics improved after resuscitation and the patients remained stable in the next days...

http://www.onlinejets.org/article.asp?issn=0974-2700;year=2015;volume=8;issue=4;spage=239;epage=240;aulast=Tugnoli
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