[Most severe liver rupture with hepatic vein avulsion and massive hemobilia]

A case report of hepatic trauma in a patient with polytrauma. For treatment of a destroying lesion of the right lobe with disruption of the middle hepatic vein right lobectomy was done. Postoperatively an excessive hyperbilirubinaemia occurred because of a closed central contusion of the left lobe with a biliovenous fistula. This diagnosis was achieved by arteriography before a second operation and intraoperative cholangiography using a T tube. Bilhaemia completely disappeared while mild negative pressure was administered to the T tube. Diagnosis and therapy of bilhaemia are discussed.