ABSTRACT
Step 3-Temporary control of active liver bleeding can often be accomplished using a combination of direct manual compression and packing. Laparotomy pads are packed between the liver and the diaphragm and between the liver and the retroperitoneum. Additionally, direct manual compression can be applied using two hands to compress the liver. If temporary control of bleeding is attained, direct pressure should be held for 10 minutes. Packing may be facilitated by partial mobilization of the liver (see below). After an appropriate interval, release pressure to determine if bleeding resumes. If not, cautiously remove the laparotomy packs. If bleeding resumes, replace the packs and restore hemostasis. Consider leaving the packs in place and returning for a “second look” laparotomy in 24-72 hours.
