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Injuries to the portal triad
D L Dawson1, K H Johansen, G J Jurkovich
1Department of Surgery, Harborview Medical Center, University of Washington School of Medicine, Seattle 98195.
American Journal of Surgery
|May 1, 1991
Summary
Injuries to the portal triad are rare but life-threatening, often missed preoperatively. Rapid hemorrhage control is critical for survival in trauma patients with these complex injuries.
Area of Science:
- Trauma Surgery
- Surgical Gastroenterology
- Vascular Surgery
Background:
- Extrahepatic portal triad injuries are uncommon, comprising only 0.21% of multiple trauma cases.
- These injuries are frequently undiagnosed preoperatively, posing significant management challenges.
Purpose of the Study:
- To review the management and clinical outcomes of patients with extrahepatic portal triad injuries.
- To identify factors influencing mortality and complications in this patient cohort.
Main Methods:
- Retrospective review of 21 patients with extrahepatic portal triad injuries over 11 years at a Level I trauma center.
- Analysis of injury patterns, management strategies, and patient outcomes, including mortality and complications.
Main Results:
- 52% of patients (11 of 21) died, primarily from uncontrolled intra-abdominal hemorrhage.
- Injuries involved the bile duct (4), portal vein (14), and hepatic artery (7), with 3 combined injuries.
- Survivors experienced high complication rates (80%), often requiring reoperation or drainage.
Conclusions:
- Extrahepatic portal triad injuries are rare, difficult to diagnose, and technically challenging.
- Mortality is directly linked to uncontrolled hemorrhage; prompt bleeding control is the priority.
- Effective management strategies include venorrhaphy for portal vein injuries and ligation for hepatic artery injuries.