Hepatic artery transection after blunt trauma: case presentation and review of the literature

Miglietta, M; Moore, Jason; Bernstein, Mark; Frangos, Spiros G.; Ginsburg, Howard B.; Pachter, H. Leon

doi:10.1016/j.jpedsurg.2006.05.001

Cited by 10 publications

(8 citation statements)

References 8 publications

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“…Puede ser necesario la resección tardía cuando un lóbulo completo del hígado se reduce sustancialmente, debido a la destrucción total del parénquima. Se debe realizar antes de que se desarrollen complicaciones secundarias debido a la necrosis hepática [7,11].…”

Section: Discussionunclassified

Trauma hepático grave con compromiso vascular y fuga biliar

Lazo

Armijos

Miranda

et al. 2022

REV-SEP

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Introducción: El hígado se lesiona con mayor frecuencia en un trauma de abdomen de alta energía, con una incidencia entre 1 % y 8 %. Las lesiones traumáticas de las vías biliares son muy raras. Casos clínicos: Presentamos dos pacientes con trauma hepático grave, y compromiso extrahepático vascular y de la vía biliar; y el abordaje quirúrgico para preservar funcionalmente ambos lóbulos: Masculino de 1 año, trauma hepático grado V, lesión incompleta de vena porta derecha, a nivel de la bifurcación y del conducto biliar hepático izquierdo. Se reparó el daño portal y de la vía biliar. Femenina de dos años, trauma cerrado de abdomen, lesión del parénquima de lóbulo derecho del hígado, sección total del conducto hepático izquierdo, y contusión pancreática asociada. En ambos casos se realizó una hepáticoyeyunostomía en Y de Roux y conservación de ambos lóbulos. Conclusión: En los traumas complejos hepáticos que involucran ambos lóbulos, la evolución depende de calidad de la masa residual. La cirugía conservadora con reconstrucciones vasculares y biliares, evita un fallo hepático agudo, permite ganar tiempo hasta la regeneración funcional del parénquima y proteger de una eventual insuficiencia hepática postoperatoria.

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Section: Discussionunclassified

Trauma hepático grave con compromiso vascular y fuga biliar

Lazo

Armijos

Miranda

et al. 2022

REV-SEP

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“…Blunt insults to a visceral artery can produce several pathological forms: pseudoaneurysm (the most common) [ 4 ], occlusion [ 5 ] or partial/complete transection. In contrast to transections, pseudoaneurysms of the hepatic artery may produce peritoneal symptoms days to months after the initial injury [ 6 ]. If the proper hepatic artery is damaged, a hematoma may arise in the porta hepatis and compress adjacent structures without any sign of hemoperitoneum [ 7 ], but the injury in our case presented with a significant abdominal bleeding since CHA is located outside of porta hepatis.…”

Section: Discussionmentioning

confidence: 99%

“…The main goal of this case report is to orient surgeons to investigate CHA injury in patients with extensive hemoperitoneum caused by relatively weaker blows to the abdomen. The blow may not be forceful enough to damage major abdominal organs, in contrast to situations where an impactful hit (as in automobile accidents) has a higher chance of damaging not only the hepatic arteries but other abdominal organs and other sections of the body [ 6 ]. The uniqueness of this case arises from the fact that of all abdominal parts, only CHA was damaged, which implies CHA may be the first target of relatively weaker abdominal injuries in a patient with no previous illnesses.…”

Section: Discussionmentioning

confidence: 99%

Isolated complete transection of common hepatic artery in a fall accident: a case report

Danial

Bedon

Kalaji

et al. 2020

Journal of Surgical Case Reports

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Blunt abdominal trauma is the most frequent external injury to the abdomen, which is rarely due to falling. However, not often does a blunt trauma cause injury to the common hepatic artery. Isolated injury of the common hepatic artery has rarely been reported in the literature. This report describes an unusual case of a falling accident from a height of 5 meters that results in complete transection of the common hepatic artery, yet all other abdominal organs are normal. The case was initially diagnosed by a Focused Assessment with Sonography in Trauma exam and confirmed with an exploratory laparotomy. The successful management would be an end-to-end anastomosis of the dissected artery. We hope we would raise awareness of such injury in order to facilitate its diagnosis and management and improve its outcome.

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“…The associated high mortality and morbidity make immediate diagnosis, accurate localization of the site of the injury and effective emergent management of the patient's condition crucial. Arterial injury in this small anatomical area after blunt abdominal injury includes pseudoaneurysm formation, and less commonly arterial occlusion or transection 3 4…”

Section: Discussionmentioning

confidence: 99%

Isolated hepatic artery injury in blunt abdominal trauma presenting as upper gastrointestinal bleeding: treatment with transcatheter embolisation

2012

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SummaryLiver injury in blunt abdominal trauma is common. However, not often does blunt trauma cause injury to the anatomical structures of the porta hepatis. Isolated injury of the hepatic artery has been rarely reported in the literature. Such injury may be lethal and requires immediate diagnosis and management. This report describes an unusual case of blunt abdominal trauma resulting in hepatic and gastroduodenal artery dissection, with pseudoaneurysm formation complicated by active upper gastrointestinal bleeding. The injury was managed by transcatheter embolisation. Awareness of this diagnosis should facilitate management of similar trauma cases. CASE PRESENTATIONA 26-year-old previously healthy man was brought to the emergency department (ED) after being involved in a street fight during which he experienced a blunt abdominal trauma 30 min prior to presentation. He had no medical history except for a splenic laceration caused by a recent blunt abdominal trauma, for which he had splenorraphy 6 weeks prior to presentation. Medical personnel at the scene of the incident reported an episode of haematemesis. However, en route to the hospital the patient was alert, oriented and haemodynamically stable. On arrival to the ED, he had another episode of massive haematemesis and was noted to be tachycardic, with a heart rate of 100 beats per min and a blood pressure of 70/30 mm Hg. His blood pressure responded to crystalloid resuscitation. The patient reported right upper quadrant and epigastric pain with several episodes of haematemesis. After patient stabilisation, a detailed physical examination revealed abrasions over the right lower rib cage. His abdomen was soft, slightly distended, with absence of significant tenderness or rigidity. INVESTIGATIONSLaboratory workup revealed a white blood cell count of 13 600/cu.mm, a haemoglobin level of 9.3 g/dl, a haematocrit of 28.0% and a normal coagulation profile. Given his response to initial crystalloid bolus and the patient's presentation with active upper gastrointestinal bleed, a contrast-enhanced CT of the chest, abdomen and pelvis was performed. His CT scan revealed contrast extravasation within the duodenum consistent with active upper gastrointestinal bleeding (figure 1). There was also a 4×4 cm haematoma in the porta hepatis showing a central area of contrast extravasation and exerting mass effect on the portal vein posteriorly and the proximal duodenum anteriorly (figure 1). The haematoma was associated with occlusion of the hepatic artery proper. The proximal hepatic and the gastroduodenal arteries were narrowed with a low-density crescent, suggestive of arterial dissection associated with pseudoaneurysm formation at the level of the haematoma. Coronal reconstruction showed a rupture into the duodenum at this level ( figure 1B). The neck of the pseudoaneurysm was identified as well as a small track from the pseudoaneurysm to the duodenal wall. A small patent right Figure 1 (A) Contrast-enhanced axial CT image, showing the pseudoaneurysm and surrounding haematom...

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Hepatic artery transection after blunt trauma: case presentation and review of the literature

Cited by 10 publications

References 8 publications

Trauma hepático grave con compromiso vascular y fuga biliar

Trauma hepático grave con compromiso vascular y fuga biliar

Isolated complete transection of common hepatic artery in a fall accident: a case report

Isolated hepatic artery injury in blunt abdominal trauma presenting as upper gastrointestinal bleeding: treatment with transcatheter embolisation

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