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liver fossa poacked to controll torrential uncontrolled heamorrhage |
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packs were removed and count confirmed |
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late pre op ct scan abdoman showing large heamoperitonium rt lower abdoman |
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early pre op ct scan showing intraparenchymal heamatoma without heamoperitoneum. |
A 68 yr old male had h/o road traffic accident 6 days back ,usg s/o intraparenchymal liver heamatoma, no free fluid, ct scan confirmed the diagnosis.pt refused to get admitted as he was vitally stable,on 8th post trauma day he got sudden breathlessness,got admitted under a cardiologist( past h/o balloon angioplasty)vitally stable( stopped antiplatelets after the day of trauma), repeat usg showed same previous findings, pt kept in icu for one day and then in ward for one day before discharging him, treated conservatively, but suddenly on the day of discharge ,he had breathlessness, perspiration, hypo tension and abdominal distension.repeat ct-scan suggested gross heamoperitoneum. pt was taken for laparotomy, with radial pulse not palpable and bp not record-able condition,on exploration about 3 lit of fresh heamoperitoneum drained with active bleeding from seg-4 and seg 6-.pringle menuver failed to control active heamorrhage, surgicel and fibriller also failed ,packing with mop done which arrested h'hage, but after removal of packing for 8 to 10 min again severe haemorrhage continued,despite of all alll attempts due to grave condition of the pt, I decided to pack the liver fossa wid 1 roller pack and six mops,soaked wid hemlock and hydrogenperoxide,.blood and blood products were given (about 20 units total).pt improved drametically was on ventilator,after 48 hours packs were removed,and counted.heamostasis achieved with gelfoam , fibrillar and surgicel.pt imroved in 2 day but then got acute lung failure (ARDS) and modf status. pt was kept again on ventilator for another 12 days and gradually improved. all culture (8 in number) were sent , few were positive for acenatobacter and enterococcus,antibiotics given accordingly pt was discharged on 20th post op day,
4 days back he completed 2 months after discharge ,happy to save someone"s life in such a hostile condition.( this is the shortest discription of this case possible)