Hepatic artery ligation and peri-hepatic packing in the management of major liver trauma: Case reports

Major hepatic trauma is often encountered in the emergent room after severe traffic accidents or impacting injuries. However, the liver is the most vulnerable intra-abdominal organ to trauma. Most liver injuries (80-90%) are major (Grade I-II) which require only close observation and supportive treatment, the remaining 10% (GrIII-V) are major injuries and uneasy to handle. Controlling hemorrhage from wounds of the liver is difficult, many traditional methods of achieving hemostasis have variable success rates. We present our experiences in three cases of using hepatic artery ligation (HAL) as an adjuvant method for those that bleeding were controlled initially by peri-hepatic packing and Pringle maneuver but with persistant hemorrhage after releasing portal triad occlusion. Successful hemostasis were obtained 48-72 hours after removal of packs, no significant hepatic function deficits observed except one patient developed intra-abdominal abscess. All patients survived.