Our results provide preliminary evidence for the reversal of the hepatic arterial buffer response following the restoration of the portal venous blood flow. This may be a short-term effect because of the restored portal venous blood flow.

Today, spleen-preserving or splenic-tissue-conserving surgery is both an accepted and desirable principle in the surgical treatment of injuries to the spleen as well as nontraumatic benign splenic lesions. In the rare case of benign tumorous lesions of the spleen, the question whether splenectomy or resection is the preferred successful therapeutic option is still being discussed. We present a case in which a high-pressure water jet dissector (Helix Hydro-Jet, A. Pein Medizintechnik, Schwerin, Germany) was used to perform an elective resection in a 13-year-old boy with a hamartoma of the spleen. The postoperative course was free of complications. The case illustrates the excellent features of water jet dissection in terms of transection of the parenchymal tissue and safe and selective hemostasis, which has also made the Hydro-Jet our preferred instrument for surgery on the splenic parenchyma.

At present thrombosis of the superior vena cava is an uncommon event that is now more frequently associated with diagnostic or therapeutic catheterization. If an apparent spontaneous thrombosis occurs, malignancy should be considered in the differential diagnosis. One case of clinically symptomatic thrombosis of the internal jugular, subclavian, and superior vena cava is presented. We detected an asymptomatic left renal cell carcinoma in a 54-year-old patient and nephrectomy was performed. Increased blood coagulability as part of a paraneoplastic syndrome was considered to be the possible etiology. In patients with otherwise unexplained superior vena cava thrombosis, examination not only of the head and neck but also of the abdomen, retroperitoneum, and pelvis should be pursued. A review of the literature pertinent to this rare case is provided.

Liver injuries may occur alone as well as within the broader context of polytrauma. Immediate surgical intervention is indicated in hemodynamically instable patients with detection of free intra-abdominal fluid as demonstrated by imaging studies. For these patients, a damage control concept has been devised in order to decrease early mortality after trauma. With this strategy complex reconstructive interventions are avoided during the initial phase. Stabilization of the patient by treatment of the lethal triad consisting of hypothermia, coagulopathy and metabolic acidosis is at the core of this therapeutic concept. Should there be a need for reconstructions or other major surgical interventions these will be performed with delay after stabilization of the patient. Packing for the temporary treatment of liver injuries is part of the damage control concept.