Operative cholangiography and special technical consideration in the management of severe injury of the liver.
The majority of hepatic injuries can be adequately managed by control of bleeding locally at the site, debridement and ample drainage. In some instances, severe blunt trauma and high velocity missile wounds may result in the disruption of intrahepatic structures and significant devitalization of the parenchyma of the liver, necessitating hepatic resection. Operative cholangiography was found to be useful in the evaluation and management of this type of severe injury to the liver. It is simple, practical method to recognize and localize a major disruption of the parenchyma of the liver and bile ducts; to help decide whether or not segmental, sublobar or labor hepatectomy should be performed, and to detect bile leaks from the divided bile ducts after resection of the liver. A modified technique for performing hepatic resection during an emergency situation was suggested to be more suitable than the classic technique. This is based on finger dissection along the line of injury and individual ligation of bile ducts and vessels as they are exposed within the parenchyma of the liver instead of isolation and ligation of the main inflow vessels and of the major ducts at the hilus and retrohepatic ligation of the hepatic veins.
D000293:Adolescent; D000328:Adult; D002758:Cholangiography / Q000379:methods; D005260:Female; D006498:Hepatectomy; D006801:Humans; D008099:Liver / Q000000981:diagnostic imaging / Q000293:injuries* / Q000601:surgery; D008297:Male; D008722:Methods