Surgical management of juxtahepatic venous injuries in blunt hepatic trauma

R. J. Chen, J. F. Fang, B. C. Lin, L. B B Jeng, M. F. Chen

Research output: Contribution to journalArticle

30 Citations (Scopus)

Abstract

The purpose of this analysis was to understand better the problems faced in the management of blunt juxtahepatic venous injuries and to try and simplify the controversies regarding the optimal surgical approach to these injuries. Charts of 92 blunt liver trauma patients treated between July 1, 1991 to June 30, 1993 were reviewed. Nineteen patients with blunt juxtahepatic venous injuries were identified. The isolated left hepatic vein injury group (five patients) were all treated using a nonshunting approach with no mortalities. Half of the isolated right hepatic vein injury group (ten patients) received an atriocaval shunt, and the other half did not. These two different approaches each produced one survivor, with a combined mortality rate of 80% (eight of ten patients). One of the combined injuries group (four patients) received a total hepatectomy followed by liver transplantation. Another received a shunt. The other two were treated without shunting, but all of them expired. The overall mortality rate was 63.2% (12 of 19 patients), with nine patients dying intraoperatively or immediately postoperatively from exsanguination. The other three died 10, 25, and 30 days postoperatively because of sepsis. Juxtahepatic venous injury should be suspected after failure of the Pringle maneuver to stop bleeding and the different venous injuries differentiated by palpation of the adjacent hepatic parenchymal injuries. If an isolated left hepatic vein injury is found and the liver parenchymal injury is limited to segments II, III, or IV, then a nonshunting approach will achieve the optimal outcome.

Original languageEnglish
Pages (from-to)886-890
Number of pages5
JournalJournal of Trauma - Injury, Infection and Critical Care
Volume38
Issue number6
DOIs
Publication statusPublished - 1995
Externally publishedYes

Fingerprint

Nonpenetrating Wounds
Liver
Wounds and Injuries
Hepatic Veins
Mortality
Exsanguination
Palpation
Hepatectomy
Liver Transplantation
Survivors
Sepsis

ASJC Scopus subject areas

  • Surgery

Cite this

Surgical management of juxtahepatic venous injuries in blunt hepatic trauma. / Chen, R. J.; Fang, J. F.; Lin, B. C.; Jeng, L. B B; Chen, M. F.

In: Journal of Trauma - Injury, Infection and Critical Care, Vol. 38, No. 6, 1995, p. 886-890.

Research output: Contribution to journalArticle

Chen, R. J. ; Fang, J. F. ; Lin, B. C. ; Jeng, L. B B ; Chen, M. F. / Surgical management of juxtahepatic venous injuries in blunt hepatic trauma. In: Journal of Trauma - Injury, Infection and Critical Care. 1995 ; Vol. 38, No. 6. pp. 886-890.
@article{35f47eca2a734ee6a6f03d2f5b04dd80,
title = "Surgical management of juxtahepatic venous injuries in blunt hepatic trauma",
abstract = "The purpose of this analysis was to understand better the problems faced in the management of blunt juxtahepatic venous injuries and to try and simplify the controversies regarding the optimal surgical approach to these injuries. Charts of 92 blunt liver trauma patients treated between July 1, 1991 to June 30, 1993 were reviewed. Nineteen patients with blunt juxtahepatic venous injuries were identified. The isolated left hepatic vein injury group (five patients) were all treated using a nonshunting approach with no mortalities. Half of the isolated right hepatic vein injury group (ten patients) received an atriocaval shunt, and the other half did not. These two different approaches each produced one survivor, with a combined mortality rate of 80{\%} (eight of ten patients). One of the combined injuries group (four patients) received a total hepatectomy followed by liver transplantation. Another received a shunt. The other two were treated without shunting, but all of them expired. The overall mortality rate was 63.2{\%} (12 of 19 patients), with nine patients dying intraoperatively or immediately postoperatively from exsanguination. The other three died 10, 25, and 30 days postoperatively because of sepsis. Juxtahepatic venous injury should be suspected after failure of the Pringle maneuver to stop bleeding and the different venous injuries differentiated by palpation of the adjacent hepatic parenchymal injuries. If an isolated left hepatic vein injury is found and the liver parenchymal injury is limited to segments II, III, or IV, then a nonshunting approach will achieve the optimal outcome.",
author = "Chen, {R. J.} and Fang, {J. F.} and Lin, {B. C.} and Jeng, {L. B B} and Chen, {M. F.}",
year = "1995",
doi = "10.1097/00005373-199506000-00010",
language = "English",
volume = "38",
pages = "886--890",
journal = "Journal of Trauma and Acute Care Surgery",
issn = "2163-0755",
publisher = "Lippincott Williams and Wilkins",
number = "6",

}

TY - JOUR

T1 - Surgical management of juxtahepatic venous injuries in blunt hepatic trauma

AU - Chen, R. J.

AU - Fang, J. F.

AU - Lin, B. C.

AU - Jeng, L. B B

AU - Chen, M. F.

PY - 1995

Y1 - 1995

N2 - The purpose of this analysis was to understand better the problems faced in the management of blunt juxtahepatic venous injuries and to try and simplify the controversies regarding the optimal surgical approach to these injuries. Charts of 92 blunt liver trauma patients treated between July 1, 1991 to June 30, 1993 were reviewed. Nineteen patients with blunt juxtahepatic venous injuries were identified. The isolated left hepatic vein injury group (five patients) were all treated using a nonshunting approach with no mortalities. Half of the isolated right hepatic vein injury group (ten patients) received an atriocaval shunt, and the other half did not. These two different approaches each produced one survivor, with a combined mortality rate of 80% (eight of ten patients). One of the combined injuries group (four patients) received a total hepatectomy followed by liver transplantation. Another received a shunt. The other two were treated without shunting, but all of them expired. The overall mortality rate was 63.2% (12 of 19 patients), with nine patients dying intraoperatively or immediately postoperatively from exsanguination. The other three died 10, 25, and 30 days postoperatively because of sepsis. Juxtahepatic venous injury should be suspected after failure of the Pringle maneuver to stop bleeding and the different venous injuries differentiated by palpation of the adjacent hepatic parenchymal injuries. If an isolated left hepatic vein injury is found and the liver parenchymal injury is limited to segments II, III, or IV, then a nonshunting approach will achieve the optimal outcome.

AB - The purpose of this analysis was to understand better the problems faced in the management of blunt juxtahepatic venous injuries and to try and simplify the controversies regarding the optimal surgical approach to these injuries. Charts of 92 blunt liver trauma patients treated between July 1, 1991 to June 30, 1993 were reviewed. Nineteen patients with blunt juxtahepatic venous injuries were identified. The isolated left hepatic vein injury group (five patients) were all treated using a nonshunting approach with no mortalities. Half of the isolated right hepatic vein injury group (ten patients) received an atriocaval shunt, and the other half did not. These two different approaches each produced one survivor, with a combined mortality rate of 80% (eight of ten patients). One of the combined injuries group (four patients) received a total hepatectomy followed by liver transplantation. Another received a shunt. The other two were treated without shunting, but all of them expired. The overall mortality rate was 63.2% (12 of 19 patients), with nine patients dying intraoperatively or immediately postoperatively from exsanguination. The other three died 10, 25, and 30 days postoperatively because of sepsis. Juxtahepatic venous injury should be suspected after failure of the Pringle maneuver to stop bleeding and the different venous injuries differentiated by palpation of the adjacent hepatic parenchymal injuries. If an isolated left hepatic vein injury is found and the liver parenchymal injury is limited to segments II, III, or IV, then a nonshunting approach will achieve the optimal outcome.

UR - http://www.scopus.com/inward/record.url?scp=0029050363&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=0029050363&partnerID=8YFLogxK

U2 - 10.1097/00005373-199506000-00010

DO - 10.1097/00005373-199506000-00010

M3 - Article

C2 - 7602629

AN - SCOPUS:0029050363

VL - 38

SP - 886

EP - 890

JO - Journal of Trauma and Acute Care Surgery

JF - Journal of Trauma and Acute Care Surgery

SN - 2163-0755

IS - 6

ER -