35 year man meets with a RTA and is rushed to the ER with suspected abdominal injury. Patient is hypotensive and FAST is positive. On laparotomy, liver appears lacerated and is actively bleeding. Surgeon performs pringles, plugging and packing but after 20-30 mins notices blood oozing from the posterior surface. Which is the most appropriate next step?
A. Carry out a mattox procedure
B. Extend the midline laparotomy incision into a thoacotomy incision
C. Heaney manoeuvre
D. Carry out a cattel branch manoeuvre
A failure of a Pringle maneuver to slow the bleeding likely indicates an injury behind the liver, to the retrohepatic inferior vena cava or a hepatic vein. One of the ways to control retrohepatic bleeding is heaney manoeuvre
The Heaney manoeuvre is performed by clamping both the suprahepatic and infrahepatic inferior vena cava while simultaneously applying the Pringle maneuver