The Telegraph
Since 1st March, 1999
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Bleeding liver holds the key

New Delhi, April 22: For hours after he was shot, Pramod Mahajan’s fate appeared to hinge on a region of his liver so extensively damaged by the bullet that tore through it that it bled incessantly, doctors said.

Pramod suffered massive blood loss from injuries to the liver, pancreas, small intestine and a major blood vessel. But it was the bleeding liver that posed the greatest challenge to doctors struggling to keep him alive.

“The bullet’s exit wound in the liver had shattered it, giving it a ragged look,” Sudhansu Bhattacharya, a cardiovascular surgeon who was in the team that operated on Pramod at Hinduja hospital, told The Telegraph. “This was the major zone of bleeding.”

That Pramod had received more than 40 bottles of blood suggests that he had “exsanguinated” ' lost all his blood ' and continued to lose even transfused blood, trauma specialists said.

An average adult has about 5 litres of blood; a standard transfusion bottle has 300 ml. Therefore, 40 bottles means 12 litres, more than twice the normal amount of blood.

The multiple transfusions were also a source of concern for doctors.

“Multiple transfusions sometimes lead to a precarious condition that deranges normal blood clotting mechanisms,” said Manjul Joshipura, a trauma surgeon in Ahmedabad and director of the Academy of Traumatology.

“While we’re trying to replace blood with multiple transfusions, the excess transfusion sometimes prevents clotting, and the bleeding continues.”

Sometimes trauma specialists decide to simply sacrifice organs that have been extensively damaged and bleeding. But this can be done only in the case of non-essential organs.

“When an injury leads to a ruptured spleen, one option is to remove the spleen. But we can’t do that for an essential organ such as the liver,” Joshipura said.

Bhattacharya said the option of removing a part of the liver “was discussed” before the surgery, but doctors decided against it because Pramod had already lost a massive amount of blood and was in a state of shock.

Army doctors visit

Two army doctors visited Hinduja hospital for consultations on Pramod’s condition on a request by Union minister Sharad Pawar. They told Pramod’s family that the treatment being given was proper, BJP spokesperson Prakash Javadekar said.

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