At 19:50 p.m. on February 5, 2024, the Department of General Surgery of Sunshine Harmony Hospital was broken by a consultation**, "A teenager was injured in a car accident, considering liver rupture, the situation is very critical, please go to the emergency room for consultation urgently." After hanging up**, the doctor on duty immediately went to the consultation, and after arriving at the emergency room, the emergency surgery doctor on duty Wang Bing had instructed the duty ** to open intravenous access for rehydration, and the on-duty ** assisted the patient's family to go through the hospitalization procedures urgently, and Dr. Wang Bing quickly introduced the condition "Patient Liu, male, 15 years old, was in a car accident at about 18:00 in the afternoon with an electric car ridden by a friend and a motor vehicle in the wrong direction, injuring the abdomen, and undergoing a whole abdominal CT in the local town health center to consider liver rupture, and was urgently transferred to Sunshine Harmony Hospital without special treatment** , the current patient's blood pressure is 75 38mmHg, the patient has liver rupture, hemorrhagic shock, and is in critical condition". Wu Bing, the doctor on duty in the Department of General Surgery, immediately reported to Director Li Sen and Director Zhao Benhe, and after Director Li Sen understood the situation, he immediately arranged emergency expansion, emergency blood preparation, and anti-shock**.
According to the results of the enhanced CT of the patient's upper abdomen, Director Li Sen judged that the patient belonged to the central contusion injury of the right posterior lobe of the liver, which belonged to grade IV or above liver injury, and at the same time, contrast agent extravasation and intestinal thickening were visible in the right abdomen, and there was vascular rupture, compared with the abdominal CT of the outer hospital when the patient was just injured, the patient's perihepatic and pelvic blood accumulation increased significantly, and the amount of intra-abdominal bleeding was more than 2000ml, the patient was in critical condition, not suitable for interventional embolization to stop bleeding, and the patient could die at any time if there was no emergency surgery**; Even if surgery is done, there is a risk of death during the operation.
Director Zhang Yueming led the anesthesiology team to face the difficulties, organized two groups of anesthesiologists, a group of blood pilots, and two groups of surgeons to start rescue surgery at 10:10 p.m., and explored a large amount of blood in the abdominal cavity during the operation, and the autologous blood infusion device ** nearly 4500ml of hemoperitoneum, and there was an irregular tear about 10cm long and about 5cm deep on the diaphragmatic surface of the right posterior lobe of the liver, and a tear of about 25cm long serous muscle layer was visible on the surface of the patient's ascending mesocolon, extending to the liver area of the transverse colon. There is a tear about 5cm long on the surface of the ascending mesangium, the ileocolic artery is broken, due to a large amount of blood loss, the blood pressure decreases to lead to thrombosis at the end of the ileocolic artery, the ascending colon ischemia is dark, no peristalsis, the anesthesiologist tries his best to maintain the patient's vital signs, and the frustrated liver is removed under the full protection of the instrument** and tour**, and the entire right colon is removed and the ileotransverse colonic anastomosis is done. During the operation, a total of about 7000ml of bleeding was carried out, and the blood of ** was washed repeatedly, and about 1500ml of autologous blood was transfused, and 6 leukocytes were transfused5U, plasma 800ml, platelet 1**, cryoprecipitate 115 units.
The whole body blood of adolescents accounts for about 7-8% of body weight, and the whole body blood is about 3000ml, which is equivalent to the replacement of whole body blood twice, due to the repeated circulation blood loss and blood transfusion of patients, resulting in the lack of coagulation factors, almost loss of coagulation function, and a wide range of blood oozing from the abdominal wound, a large amount of gauze tamponade compression can change the coagulation status of the organ. Take a 600cm 100cm sterile bandage roll, fold the gauze repeatedly in a square shape after opening, place the folded gauze on the liver wound, leave the end about 10cm outside the abdominal cavity, place 1 drainage tube on the outside of the liver and pelvis, and close the abdomen layer by layer, and the operation ended at 3:30 on February 6. After the operation, the anesthesiologist maintained the patient's vital signs relatively stable and transferred to the intensive care department with endotracheal intubation under anesthesia, and the medical team of the intensive care medicine department led by Director Zhang Yueming continued to provide ventilator to assist breathing, contact the blood transfusion department for blood transfusion, and apply vasoactive drugs to maintain stable vital signs, anti-infection, rehydration and other symptomatic treatment.
On February 7, Director Li Sen led all the doctors of the Department of General Surgery to the Department of Intensive Care Medicine for rounds, and under the close monitoring of the Department of Intensive Care Medicine, the patient's vital signs and coagulation status tended to be stable, and the tracheal intubation was successfully removed after 36 hours.
Although the operation was successfully completed, the patient still faces the risk of many complications, such as: rebleeding, infection, intestinal anastomotic leakage, biliary fistula, etc., which is no less dangerous than the operation itself.
Liver rupture is a more serious condition.
Liver trauma surgery is associated with the greatest risk of abdominal organ injury and a very high mortality rate. Liver rupture accounts for about 15% to 20% of all abdominal trauma, and traffic accidents are one of the most common causes.
The liver is located in the right subdiaphragm and deep surface of the hypochondrium, protected by the thoracic cage and diaphragm, and is generally not easy to damage, but because the liver is fragile, rich in blood vessels, and fixed by surrounding ligaments, it is also susceptible to external violence or sharp object puncture wounds that cause rupture and bleeding.
Liver rupture is a more serious situation, there are abundant blood vessels in the liver, and there is also a biliary system, once the liver ruptures, the blood vessels in the liver will cause serious bleeding, prone to hemorrhagic shock and even lead to death.
The total amount of blood of healthy normal adults is equivalent to 7-8% of body weight, circulating blood loss, blood transfusion is often accompanied by the loss of coagulation factors, resulting in coagulation dysfunction, coagulation dysfunction, wound bleeding routine hemostasis, platelet, plasma, cryoprecipitate effect is not good, the traditional mechanical hemostasis can be used, 24-48 hours later, the patient's hematopoietic function gradually recovers, when the coagulation function tends to be stable, the gauze can be removed again, and the desired effect can often be achieved.
The successful treatment of this patient demonstrates the ability of Sunshine Harmony Hospital to treat critical and serious patients, and it is also a review of the close cooperation between the departments of General Surgery, Emergency Department, Operating Room, Anesthesiology Department, Blood Transfusion Department, Intensive Care Unit and Imaging Department of Sunshine Harmony Hospital.
Sunshine Harmony Hospital is a large-scale comprehensive medical institution integrating medical treatment, teaching, scientific research, prevention, health care, translational medicine and industrial development jointly established by Sunshine Insurance Group and Weifang City under the new situation of national medical reform, approved by the China Insurance Regulatory Commission. It is one of the few large-scale non-public general hospitals in the country that has obtained international JCI accreditation (seventh edition), HIMSS7 rating and domestic top three evaluation, and three highly influential and representative international and domestic authoritative certifications, and served as a provincial centralized treatment center for new crown pneumonia during the new crown epidemic. The hospital has been identified as a designated hospital for medical examination of model workers in the national financial system, a national civilized unit, the best volunteer service project in the country, a national management innovation hospital, a May Day Labor Award in the national financial system, a national humanistic management innovation hospital, an advanced health unit in Shandong Province, a demonstration hospital for improving medical services in Weifang City, a medical institution trusted by Weifang citizens, a national medical insurance, a medical insurance designated medical institution in Shandong Province, a designated medical institution for medical insurance in Weifang City, and a regional medical center in Weifang City.