Journal of Emergencies, Trauma, and Shock
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CASE REPORT
Year : 2020  |  Volume : 13  |  Issue : 4  |  Page : 306-308

Grade IV liver injury following mechanical cardiopulmonary resuscitation with postoperative three-dimensional evaluation


1 Department of Emergency, ASST Grande Ospedale Metropolitano Niguarda; Department of Biomedical and Clinical Sciences “L. Sacco”, University of Milan, Milan, Italy
2 Department of Biomedical and Clinical Sciences “L. Sacco”, University of Milan, Milan, Italy
3 Department of Biomedical and Clinical Sciences “L. Sacco”, University of Milan; Department of Radiology, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
4 Department of Cardiovascular, ASST della Valtellina e dell'Alto Lario, Sondrio, Italy
5 General Surgery and Trauma Team, ASST Grande Ospedale Metropolitano Niguarda; Department of Pathophysiology and Transplantation, University of Milan, Milan, Italy
6 Department of Radiology, ASST Grande Ospedale Metropolitano Niguarda; Department of Oncology and Hemato-Oncology, University of Milan, Milan, Italy
7 Department of Biomedical and Clinical Sciences “L. Sacco”; CIMaINa (Interdisciplinary Centre for Nanostructured Materials and Interfaces), University of Milan, Milan, Italy

Correspondence Address:
Dr. Francesco Rizzetto
Department of Radiology, ASST Grande Ospedale Metropolitano Niguarda, Piazza Ospedale Maggiore 3, 20162 Milan
Italy
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/JETS.JETS_28_20

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A 48-year-old female presented to the emergency department with chest pain and collapsed at the front desk. She was reanimated with mechanical chest compression, and after coronary angiography, a left anterior descending/diagonal bifurcation mini-crush stenting was performed. Few hours after the procedure, the patient showed severe hypotension. Abdominal ultrasound and computed tomography (CT) scan evidenced a massive subcapsular liver hematoma (Grade IV, American association for the surgery of trauma (AAST) liver injury scale) of the right lobe with extrahepatic blushing. Transhepatic embolization was attempted but without benefit, so the patient underwent emergency laparotomy for damage control surgery with perihepatic packing. After hemodynamic stabilization, right hepatectomy was performed with a favorable outcome and full recovery. The patient CT scan was retrospectively processed to obtain a virtual model visualizable through a head-mounted display. The virtual reconstruction could improve the comprehension of the injury and the liver surgical anatomy for educational purpose, and it could represent a new tool for preoperative planning.


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