RT Journal Article
SR Electronic
T1 Traumatic bruising of the hepatoduodenal ligament can conceal a catastrophic injury to the hepatic artery
JF BMJ Case Reports
JO BMJ Case Reports
FD BMJ Publishing Group Ltd
SP e230706
DO 10.1136/bcr-2019-230706
VO 12
IS 9
A1 Adam Daniel Gerrard
A1 Raimundas Lunevicius
A1 Nicholas Heavey
YR 2019
UL http://casereports.bmj.com/content/12/9/e230706.abstract
AB 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.