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A rational approach to serious blunt hepatic injury.

Based on our cumulative experience in patients with serious blunt liver trauma, hepatic resection is seldom necessary where cross-clamping the hepatoduodenal ligament (portal triad) effectively stops parenchymal hemorrhage. Oversewing or "hemo-clipping" of intrahepatic disrupted vascular tributaries combined, when appropriate, with lobar hepatic arterial ligation and transposition of an omental pedicle graft into the "fracture" defect is usually sufficient treatment. On the other hand, avulsion of hepatic veins and/or tears of the retrohepatic vena cava require major hepatic resection primarily for exposure. But even in conjunction with internal vena caval bypass shunts, the mortality with this injury remains high.