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Learning from errors
Case report
Traumatic bruising of the hepatoduodenal ligament can conceal a catastrophic injury to the hepatic artery
  1. Adam Daniel Gerrard1,
  2. Raimundas Lunevicius1,2 and
  3. Nicholas Heavey3
  1. 1 Department of General Surgery, Aintree University Hospital NHS Foundation Trust, Liverpool, UK
  2. 2 School of Medicine, University of Liverpool, Liverpool, UK
  3. 3 Aintree University Hospital NHS Foundation Trust, Liverpool, UK
  1. Correspondence to Raimundas Lunevicius, raimundas.lunevicius{at}aintree.nhs.uk

Abstract

We present the case of a 22-year-old man transferred to the regional major trauma centre following a fall of ~15 m. He remained consistently haemodynamically stable for over 10 hours of observation until he deteriorated suddenly with major haemorrhagic shock requiring immediate trauma laparotomy. At laparotomy, 2 L of blood was drained from the abdomen but no source of active bleeding identified. 30 minutes after closure of the abdomen, 500 mL of fresh blood was noted in the drain so he was returned to the theatre where the bleeding source was found to be—after manual compression of a mildly bruised hepatoduodenal ligament—the proper hepatic artery (PHA). This case describes an unusual finding at relaparotomy and shows that even when there is no active bleeding from abdominal organs or classified vessels, it is possible to have isolated injury to PHA.

  • general surgery
  • trauma

https://doi.org/10.1136/bcr-2019-230706

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    Footnotes

    • Contributors RL conceived and planned the case report with a summary of the published literature. ADG identified the papers, analysed them, extracted relevant data and wrote the first draft of the manuscript. RL prepared figures and table. RL and ADG authors contributed to subsequent revisions. NH wrote ‘Patient’s perspective’. All authors approved a final version of the manuscript.

    • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

    • Competing interests None declared.

    • Provenance and peer review Not commissioned; externally peer reviewed.

    • Patient consent for publication Not required.