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Juxtahepatic Venous Injuries: Emergency Measures, Definitive Control, and Atriocaval Shunts

  • Donald D. TrunkeyEmail author
  • K. Shad Pharaon
Chapter

Abstract

The liver is one of the most frequently injured organs in abdominal trauma. The anterior location in the abdominal cavity and fragile parenchyma make this organ vulnerable to injury. Prior to World War II, the mortality from liver injuries that were diagnosed and operated on was very high. After World War II, a better working knowledge in the anatomy of the liver, popularized by Couinaud, and subsequent liver transplantation furthered our understanding of the liver and how to more safely operate. Even with these advances, until about twenty years ago, many liver injuries were still operated on with lethal outcomes. The operations were time consuming and prone to significant blood loss.

Keywords

Liver Injury Hepatic Vein Inferior Vena Pringle Maneuver Portal Triad 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

Supplementary material

Video 6

Pringle maneuver (MP4 14015 kb)

Video 9

Hepatic vascular exclusion (MP4 99239 kb)

Video 12

Atriocaval shunt (MP4 256971 kb)

Suggested Readings

  1. Burch JM, Feliciano DV, Mattox KL. The atriocaval shunt: facts and fiction. Ann Surg. 1988;207(5):555–68.PubMedCrossRefPubMedCentralGoogle Scholar
  2. Krige JE, Worthley CS, Terblanche J. Severe juxtahepatic venous injury: survival after prolonged hepatic vascular isolation without shunting. HPB Surg. 1990;3(1):39–43.PubMedCrossRefPubMedCentralGoogle Scholar
  3. Pringle JH. Notes on the arrest of hepatic hemorrhage due to trauma. Ann Surg. 1908;48:541.PubMedCrossRefPubMedCentralGoogle Scholar
  4. Richardson JD, Franklin GA, Lukan JK. Evolution in the management of hepatic trauma: a 25-year perspective. Ann Surg. 2000;232:324–30.CrossRefGoogle Scholar
  5. Rogers FB, Reese J, Shackford SR, Osler TM. The use of venovenous bypass and total vascular isolation of the liver in the surgical management of juxtahepatic venous injuries in blunt hepatic trauma. J Trauma. 1997;43(3):530–3.PubMedCrossRefGoogle Scholar
  6. Schrock T, Blaisdell FW, Mathewson Jr C. Management of blunt trauma to the liver and hepatic veins. Arch Surg. 1968;96:698–704.PubMedCrossRefGoogle Scholar
  7. Strong RW. The management of blunt liver injuries. Aust N Z J Surg. 1999;69(8):609–16.PubMedCrossRefGoogle Scholar
  8. Trunkey D, Shires T, McClelland R. Management of liver trauma in 811 consecutive patients. Ann Surg. 1974;179:722–8.PubMedCrossRefPubMedCentralGoogle Scholar
  9. Ivatury RR. Basic operative techniques in trauma and emergency surgery. In: Britt LD, Peitzman A, Barie P, Jurkovich G, editors. Acute care surgery. Philadelphia: Lippincott Williams & Wilkins; 2012.Google Scholar

Copyright information

© Springer Science+Business Media New York 2015

Authors and Affiliations

  1. 1.Section of Trauma and Critical Care, Department of SurgeryOregon Health and Science UniversityPortlandUSA
  2. 2.Division of Trauma, Critical Care, and Acute Care Surgery, Department of SurgeryOregon Health and Science UniversityPortlandUSA
  3. 3.Division of Trauma and Acute Care Surgery, Surgical Critical CarePeaceHealth Southwest Medical CenterVancouverUSA

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