Intrahepatic Balloon Tamponade for Penetrating Liver Injury: Rarely Needed but Highly Effective.

BACKGROUND: Severe penetrating liver injuries are associated with high rates of morbidity and mortality. The objective of this study was to demonstrate the 15-year experience of a Level 1 US trauma center with use of intrahepatic balloon tamponade for penetrating liver injuries in adult patients. METHODS: Operative notes were used to identify cases employing intrahepatic balloon tamponade. Charts were reviewed for patient characteristics, injury characteristics, morbidity, and in-hospital mortality. RESULTS: Of the 4961 penetrating trauma patients admitted during the study period, 279 (5.6%) had liver injury and underwent exploratory laparotomy. Intrahepatic balloon tamponade was attempted in nine patients (3.2%). Two of the nine patients (22%) were in cardiac arrest at time of balloon placement and died during the index operation; both had retrohepatic IVC injury combined with cardiopulmonary injury. In patients who reached the operating room alive and had spontaneous circulation at the time of balloon placement, utilization of this technique was associated with 100% survival. CONCLUSION: Although rarely needed, trauma surgeons must be prepared to use intrahepatic balloon tamponade as one surgical technique to control major hepatic injuries.