In this video we present a laparoscopic washout following a blunt hepatic injury. A 36 year-old man sustained a significant liver injury from a fall. On CT scan the patient was found to have a large, subcapsular hematoma with no evidence of extravasation. The patient had a moderate amount of hemoperitoneum. He was admitted for nonoperative management. He remained hemodynamically stable and serial hemoglobins remained stable. On hospital day 4 the patient developed abdominal distention and respiratory distress. He was taken to the OR for laparoscopic exploration. Nearly 2 liters of blood was removed from his abdomen. There was no evidence of active bleeding or bile leakage. His small bowel was examined to exclude occult injury. We discuss the indications and techniques of laparoscopy in trauma and briefly review the literature.

The majority of blunt hepatic injuries are managed nonoperatively. Laparoscopy plays a role in addressing the complications resulting from this management. Specifically, drainage of retained hemoperitoneum, bile peritonitis, and perihepatic collections can be managed laparoscopically. The morbidity of a midline laparotomy can be avoided in select patients.