PMC9871612_01
CT scan of liver trauma and procedure of laparoscopy by infrahepatic IVC clamping. (A) CT scan showing liver laceration involving segments I and IV; (B) CT scan showing extensive hemoperitoneum around the liver; (C) laparoscopy showing the perihepatic hemorrhage and blood clot; (D) infrahepatic IVC taped with a vessel loop; (E) laceration in the anterior wall of retrohepatic IVC was clearly exposed by laparoscopy without bleeding in the condition of the Pringle maneuver and infrahepatic IVC partial clamping; (F) laceration was safely sutured. Sp, spiegel lobe; Ls, left lateral section.
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F1
The CT scan showed hemoperitoneum, liver laceration involving segments I and IV, and rib fracture, without other concomitant organ injuries (Figures 1A,B). To reduce further bleeding, after suction of perihepatic hemorrhage, the location of bleeding was temporarily compressed with gauze and then the infrahepatic IVC was dissected below the hepatoduodenal ligament and taped with a vessel loop above the left renal vein (Figure 1D). IVC partial clamping, a laceration in the anterior wall of retrohepatic IVC resulting from a hepatic short vein injury was detected after mobilization of the caudate lobe, and it was safely sutured by a 5-0 Prolene suture (Figures 1E,F). If the laceration was large, to reduce the risk of gas embolism or further bleeding, a laparoscopic bulldog clip could be applied to clamp part of the IVC wall before suturing if feasible.