Successful surgical management of a case of type IIIb liver injury with blunt traumatic rupture of the thoracic aorta by staged operation

We report a patient with severe liver injury and traumatic rupture of the aorta successfully managed by staged operation. A 40-year-old man injured in a motor vehicle accident was taken to a hospital in hemorrhagic shock. Chest roentogenography showed left hemothorax and widening of the upper mediastinum. Abdominal computed tomography (CT) showed type III b liver injury and periaortic hematoma. Abdominal packing and coil embolization were conducted for the liver injury. The patient was transferred to our hospital because aortography showed a pseudoaneurysm of the proximal descending aorta. On admission, the hemodynamic state was relatively stable, and we decided to conduct delayed repair of the traumatic aortic injury due to hypothermia-acidosis-coagulopathy syndrome. The second operation was performed 48 hours after the initial operation. Prosthetic graft replacement was conducted for the aortic injury, and hepatorrhaphy for the liver injury. The patient was discharged on day 70 after the second operation. Urgent surgical treatment is necessary for traumatic rupture of the aorta. However, in severe injury to other organs, repair of the aortic injury should be considered after hemorrhage from other organs is controlled or hypothermia-acidosis-coagulopathy syndrome improves.