A 17-year-old man with no morbid history was admitted on July 24, 1992 to the Emergency Unit of the Hospital Clínico Regional de Valdivia, 20 minutes after suffering concrete crush and closed camal.
On examination, the patient was conscious, oriented temporospatially, pale, tachycardic (pulse 112x' weak), hypotensive (PA 70/50 mmHg), with tenderness of the left abdominal cavity, multiple erosions.
Abdominal ultrasound showed free fluid, without identifying liver injury.
Once she was admitted to the hospital, she was diagnosed with complicated abdominal trauma and probable hollow fracture, left forearm, right hemopneumothorax fracture, volar fracture, two hours after admission.
Right pleurostomy was installed, leaving air and blood.
The supraumbilical midline laparotomy, hemoperitoneum of 3 l, was identified a single hepatic lesion, parallel to the falciform ligament, which dissected the liver in two.
No control of bleeding was achieved with Pringle maneuver, identifying the source of bleeding in the supra and retrohepatic vena cava.
It was decided to perform an atriocaval shunt, extending a complete hepatic incision to the right vein and a right laparotomy. An orotracheal tube 7.5 was installed through the right atrium, yielding bleeding and a vena cava suture 1 cm.
During surgery, 10 U of whole blood, 3 U of red blood cells, 5 U of cryoprecipitations, 2 U of platelets and 6 U of plasma were transfused.
He was admitted to the Intensive Care Unit (ICU) with BP 100/60 mmHg, pulse 162 x', CVP 16 cmH2O.
The patient was connected to mechanical ventilation that was maintained for 48 h, followed by intravascular coagulation.
Establishment plan approved by the Research Ethics Committee of the Federal University of Minas Gerais.
