Liver and spleen injury management in combat

The management of liver and spleen injuries in the operational environment presents unique challenges to the military surgeon. The clock started long before the patient got to the military medical treatment facility. It is incumbent upon the deployed surgeon to be very familiar with the damage control philosophy in order to identify and treat the lethal triad of acidosis, hypothermia, and coagulopathy. Damage control resuscitation and damage control surgery are temporizing therapies to save lives. Solid organ injury in the abdomen after combat injury is predominantly a surgical disease. The key concepts for a successful operation are exposure and expedience. In addition, in the damage control scenario, it is crucial that the surgeon knows how much operating is too much operating. Splenectomy is the procedure of choice for battlefield splenic injuries with hemodynamic instability or significant transfusion requirement. Hepatic injuries are best managed at initial exploration by packing to restore the gross anatomic structure of the liver. Pringle maneuver, hepatic mobilization, and exclusion techniques may be necessary for a more severe injury.