Packing the Abdomen in Catastrophic Hepatic Transection

A 29-year-old restrained driver is brought after a high-speed motor-vehicle collision. On arrival, the patient is pale, confused, and hypotensive with abdominal distention and diffuse tenderness. Initial blood-product resuscitation produces only transient improvement, but the patient remains sufficiently responsive to proceed directly to the operating room. ED FAST is positive in the right upper quadrant and pelvis. The trauma team performs an emergency exploratory laparotomy. At operative exposure, the uploaded image becomes available: the abdomen contains massive hemoperitoneum, and the liver is visibly split into two major portions with active diffuse hemorrhage. The immediate operative challenge is temporary hemorrhage control rather than definitive hepatic reconstruction.