Citation

Leppäniemi AK, Jokelainen OS, Haapiainen RK. Eur. J. Surg. 1993; 159(6-7): 351-353.

Affiliation

Second Department of Surgery, Helsinki University Central Hospital, Finland.

Copyright

(Copyright © 1993, Taylor & Francis)

DOI

unavailable

PMID

8104496

Abstract

OBJECTIVE: To report our experience in the management of accidental injuries to the structures of the hepatoduodenal ligament. DESIGN: Retrospective study of medical records. SETTING: University department of surgery. SUBJECTS: 8 patients admitted after accidents (road traffic accidents, n = 4; falls, n = 2; and gunshot and stab wounds, n = 1 each) who were found at laparotomy to have injuries of the structures of the hepatoduodenal ligament. INTERVENTIONS: Laparotomy in all cases. MAIN OUTCOME MEASURES: Morbidity and mortality. RESULTS: One patient died (13%) of multiple organ failure after a gunshot wound of the portal vein, liver, inferior vena cava, right renal artery, and right kidney. All patients had associated injuries. There were 3 complete transsections of the common bile duct, two of which were treated by Roux-en-Y cholecystojejunostomy and one by choledochojejunostomy over a T tube. Two lacerations of the common hepatic duct were treated by T tube choledochostomy. All injuries to blood vessels were sutured. Only one patient survived without any complications, and two developed cholangitis after cholecystojejunostomy that required further operation 5 and 16 months after the initial operation. CONCLUSIONS: Blunt injuries to the hepatoduodenal ligament are easily overlooked, leading to delayed morbidity. Complete transsections of the bile duct are best managed by choledochojejunostomy with a Roux-en-Y loop; T tube choledochostomy is usually sufficient when treating small partial lesions of lobar bile ducts; and most non-circumferential vascular lesions are best treated by suture.

Language: en