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Traumatic injuries to the portal vein: case study
Jonathan Pearl1, Alexander Chao, Susan Kennedy
1Department of Surgery, National Naval Medical Center, Bethesda, Maryland, USA.
The Journal of Trauma
|June 10, 2004
Summary
Portal vein injuries are rare but serious, often caused by penetrating trauma. Prompt hemorrhage control and timely surgical decisions, such as venorrhaphy or ligation, are crucial for survival.
Area of Science:
- Trauma surgery
- Vascular surgery
- Surgical outcomes
Background:
- Portal vein injuries are infrequent but carry significant morbidity and mortality.
- Management strategies for portal vein injuries remain a subject of debate in contemporary literature.
Purpose of the Study:
- To provide an updated review of portal vein injury management.
- To contribute data on the outcomes of portal vein injuries.
Main Methods:
- A 10-year retrospective review of portal vein injuries at a Level 1 trauma center.
- Analysis of patient demographics, injury mechanisms, management strategies, and outcomes.
Main Results:
- Fifteen portal vein injuries occurred over 10 years, all from penetrating trauma (0.08% of trauma patients).
- The overall survival rate was 60%, with exsanguination being the primary cause of death.
- Common postoperative complications included sepsis and wound infection in survivors. Survival rates were 86% for venorrhaphy and 67% for ligation.
Conclusions:
- Portal vein injuries are rare, with exsanguination as the leading cause of mortality.
- Effective management hinges on rapid hemorrhage control and decisive surgical intervention (venorrhaphy or ligation).
- Ligation is a viable option for hemodynamically unstable patients.