A 17-year-old boy is admitted to the hospital after a road traffic accident. Per abdomen examination is normal. After adequate resuscitation, his pulse rate is 80/min and BP is 110/70 mm Hg. Abdominal CT reveals 1 cm deep laceration in the left lobe of the liver extending from the done more than half way through the parenchyma. Appropriate management at this time would be:
Conservative treatment
Abdominal exploration and packing of hepatic wounds
Abdominal exploration and ligation of left hepatic aery
Left hepatectomy
Classification of liver injury (Moore) Grade Types Operative or CT Scan findings I Hematoma Laceration Subcapsular, <10% of surface area Capsular tear, < 1 cm in parenchymal death II Hematoma laceration Subcapsular, 10-50% of surface area Intraparenchymal, <10 cm in diameter 1-3 cm in parenchymal depth, <10 cm in length III Hematoma laceration Subcapsular, >50% of surface area or expanding; rupture subcapsular or parenchymal hematoma Intraparenchymal, hematoma > 10 cm or expanding > 3 cm in parenchymal depth IV Laceration Parenchymal disruption involving 25-75% of the hepatic lobe or 1-3 couinauds segments in a single lobe V Laceration vascular Parenchymal disruption involving >75% of the hepatic lobe or > 3 Coulnauds segments in a single lobe Juxta hepatic venous injuries, i.e retro hepatic vena cava / central major hepatic veins VI Vascular Hepatic avulsion
Trauma