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Portal triad injuries

G J Jurkovich1, D B Hoyt, F A Moore

  • 1Harborview Medical Center, University of Washington, Seattle, WA 98040, USA.

The Journal of Trauma
|September 1, 1995
PubMed
Summary
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Portal triad injuries are rare, lethal trauma complications. Prompt hemorrhage control and primary repair or enteric anastomosis for bile duct injuries improve survival rates.

Area of Science:

  • Trauma Surgery
  • Surgical Management
  • Hepatobiliary Surgery

Background:

  • Injuries to the portal triad (portal vein, hepatic artery, bile duct) are infrequent but severe challenges in trauma care.
  • These injuries often present with associated trauma, significantly increasing complexity and mortality.

Purpose of the Study:

  • To characterize the incidence, mortality, and effective management strategies for portal triad injuries.
  • To identify key factors influencing survival and complications in patients with these injuries.

Main Methods:

  • Retrospective review of data from eight academic Level I trauma centers.
  • Analysis of 118 cases of injuries to the portal triad structures over a 62-year period.

Main Results:

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  • Overall mortality for portal triad injuries was 51%, increasing to 80% with combined injuries. Exsanguination was the leading cause of intraoperative death.
  • Primary repair of portal vein injuries had higher survival (58%) than ligation (10%). Hepatic artery ligation (42%) had better survival than primary repair (14%).
  • Biliary-enteric anastomosis (89%) and ligation of lobar bile ducts (100%) were more successful than primary repair (50%) for bile duct injuries. Missed injuries led to 75% complication rate.

Conclusions:

  • Portal triad injuries are rare and highly lethal, with intraoperative hemorrhage control being paramount.
  • Timely identification and appropriate repair (primary or anastomosis) or ligation of bile duct injuries are crucial for patient outcomes.
  • Aggressive hemorrhage control and optimized surgical techniques are essential for improving survival in patients with these complex injuries.