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Severe liver trauma with complex portal and common bile duct avulsion:A case report and review of the literature

World Journal of Clinical Cases 2023年第16期11卷 3837-3846页

作者： Bianca Mitricof alin kraft Florentina Anton Alexandru Barcu Darina Barzan Carmen Haiducu Vladislav Brasoveanu Irinel Popescu Cosmin Alec Moldovan Florin Botea Medicine Doctoral School Titu Maiorescu University of BucharestBucharest 040441Romania Department of General Surgery Regina Maria Military Emergency HospitalBrasov 500007Romania Faculty of Medicine Carol Davila University of Medicine and PharmacyBucharest 050474Romania Dan Setlacec Center for General Surgery and Liver Transplant Fundeni Clinical InstituteBucharest 022328Romania Department of Medical-Surgical and Prophylactic Disciplines Faculty of MedicineTitu Maiorescu University of BucharestBucharest 031593Romania Department of General Surgery Witting Clinical HospitalBucharest 010243Romania

BACKGROUND Given its size and location,the liver is the third most injured organ by abdominal *** to recent advances,it is unanimously accepted that the nonoperative management is the current mainstay of treatment for hemodynamically stable ***,those patients with hemodynamic instability that generally present with severe liver trauma associated with major vascular lesions will require surgical ***,an associated injury of the main bile ducts makes surgery compulsory even in the case of hemodynamic stability,thereby imposing therapeutic challenges in the tertiary referral hepato-biliopancreatic centers’*** SUMMARY We present the case of a 38-year-old male patient with The American Association for the Surgery of Trauma grade V liver injury and an associated right branch of portal vein and common bile duct avulsion,due to a crush *** patient was referred to the nearest emergency hospital and because of the hemorrhagic shock,damage control surgery was performed by means of ligation of the right portal vein branch and right hepatic artery,and hemostatic ***,the patient was referred immediately to our tertiary hepato-bilio-pancreatic *** performed depacking,a right hepatectomy and Roux-en-Y *** the 9th postoperative day,the patient developed a high output anastomotic bile leak that required a redo of the *** postoperative period was marked by a surgical incision site of incomplete evisceration that was managed non-operatively by negative wound *** follow-up was optimal,with no complications at 55 *** In conclusion,the current case clearly supports that a favorable outcome in severe liver trauma with associated vascular and biliary injuries is achieved thru proper therapeutic management,conducted in a tertiary referral hepato-bilio-pancreatic center,where a stepwise and complex surgical approach is mandatory.

关键词： Severe Liver Trauma Avulsion Right portal vein Common bile duct Case report

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