Massive Hepatic Hemorrhage: Identification

  • Adrian W. OngEmail author
  • Vicente Cortes
  • Aurelio Rodriguez


Quick recognition of the bleeding patient and rapid deployment of the trauma team are essential. Focused sonography in trauma should be used in all cases expeditiously. Unstable patients with suspicion of intra-abdominal hemorrhage should have immediate laparotomy. Liver bleeding is readily apparent and most can be controlled using liver compression, packing, and local hemostatic maneuvers, with or without hepatoduodenal ligament occlusion. Bleeding not responsive to these measures usually signifies juxtahepatic venous hemorrhage and will usually require mobilization of the liver for exposure and hemostasis.


Pringle Maneuver Trauma Team Blunt Trauma Patient Trauma Room Anterolateral Thoracotomy 
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Supplementary material

Video 2

Right hepatic lobe rotation (MP4 42120 kb)

Video 3

Right hepatic lobe rotation (3-D animation) (MP4 33079 kb)

Video 6

Pringle maneuver (MP4 14015 kb)

Video 7

Liver suture (MP4 39685 kb)

Video 9

Hepatic vascular exclusion (MP4 99239 kb)

Video 10

Omental pack (MP4 32585 kb)

Video 11

Digital compression (MP4 16750 kb)


  1. 1.
    Eastridge BJ, Salinas J, McManus JG, Blackburn L, Bugler EM, Cooke WH, et al. Hypotension begins at 110 mm Hg: redefining “hypotension” with data. J Trauma. 2007;63(2):291–9.PubMedCrossRefGoogle Scholar
  2. 2.
    Quinn AC, Sinert R. What is the utility of the Focused Assessment with Sonography in Trauma (FAST) exam in penetrating torso trauma? Injury. 2011;42(5):482–7.PubMedCrossRefGoogle Scholar
  3. 3.
    Bickell WH, Wall Jr MJ, Pepe PE, Martin RR, Ginger VF, Allen MK, et al. Immediate versus delayed fluid resuscitation for hypotensive patients with penetrating torso injuries. N Engl J Med. 1994;27(17):1105–9.CrossRefGoogle Scholar
  4. 4.
    Seamon MJ, Fisher CA, Gaughan JP, Kulp H, Dempsey DT, Goldberg AJ. Emergency department thoracotomy: survival of the least expected. World J Surg. 2008;32:604–12.PubMedCrossRefGoogle Scholar
  5. 5.
    Moore EE, Knudson MM, Burlew CC, Inaba K, Dicker RA, Biffl WL, et al. Defining the limits of resuscitative emergency department thoracotomy: a contemporary Western Trauma Association perspective. J Trauma. 2011;70(2):334–9.PubMedCrossRefGoogle Scholar
  6. 6.
    McKenney KL, McKenney MG, Cohn SM, Compton R, Nunez DB, Dolich M, et al. Hemoperitoneum score helps determine need for therapeutic laparotomy. J Trauma. 2001;50(4):650–4.PubMedCrossRefGoogle Scholar
  7. 7.
    Matsumoto H, Ohshiro K. Ultrasound in abdominal trauma. In: Machi J, Sigel B, editors. Ultrasound for surgeons. New York/Tokyo: IGAKU-SHOIN Medical Publishers; 1997. p. 72–9.Google Scholar

Copyright information

© Springer Science+Business Media New York 2015

Authors and Affiliations

  • Adrian W. Ong
    • 1
    Email author
  • Vicente Cortes
    • 2
  • Aurelio Rodriguez
    • 3
  1. 1.Department of SurgeryReading HospitalWest ReadingUSA
  2. 2.Department of SurgeryReading HospitalWest ReadingUSA
  3. 3.Division of Trauma/Critical Care, Department of SurgeryConemaugh Memorial HospitalJohnstownUSA

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