[Conservative treatment of cavo-hepatic traumatic disinsertion. Report of one case (author's transl)]

Lesions of the main hepatic veins constitute a special entity in the field of liver trauma. Their originality resides: in their immediate severity (difficulty of hemostasis) and secondary consequences (disturbance of the venous blood flow), in their frequent association with other traumatic lesions, The serious consequences of partial emergency hepatectomy which is the usual treatment. There are a number of factors which permit one to propose in a certain number of favourable cases, treatment of the wound or disinsertion of a hepatic vein by vascular ligature, or, preferably, reinsertion on the inferior vena cava after prior suture, associated with conservation of the hepatic parenchyma affected by the vascular lesion. This method seems to us particularly justified when there exist accessory hepatic veins undamaged during the trauma. The possibility of secondary complications cannot be excluded, but in the special case of severe multiple trauma, the immediate vital prognosis is more important than the risk of secondary complications and the difficulty of possible reoperation. Favoured by modern means of vascular exclusion of the liver, conservative treatment may have a place in lesions of the hepatic veins where emergency partial hepatectomy cannot be undertaken without a risk to life.