Introduction. There is analyzed a clinical case of successful multi-level treatment of the combined gunshot wound of liver with the mechanism of hydrodynamic shock using “damage control” management.
Materials and methods. The patient experienced a combined thoraco-abdominal injury as a result of warfare on the east of Ukraine. The blind fragmental penetrating trauma of the chest cavity led to the rupture of the right dome of diaphragm and liver (S3–S6) by the mechanism of hydrodynamic kick (fragments of the wreckage and input/output openings in the abdominal cavity were not found).
Results. The “damage control” management was implemented as follows. On the second level of medical care the rupture of the liver parenchyma eliminated by repeated firmwares with omentopexy. The post-traumatic period proceeded with the several consecutive complications: cutting the liver sutures, the arrosive bleeding from the right hepatic artery and the irreversible ischemia of the liver S5–S6. These complications were liquidated gradually on the IV level of medical care by the transpupillary choledochal stenting, vascular suture and the imposition of a typical anatomical resection of liver S5,6.
Conclusion. Successful treatment of patients with the severe fragmental gunshot thoraco-abdominal injuries should be based on a clear understanding of the stages of traumatic disease and expected complications of parallel conducting medical evacuation, using “damage control” management at all levels of medical care.