Accidental injuries of the hepatoduodenal ligament.
OBJECTIVE
To report our experience in the management of accidental injuries to the structures of the hepatoduodenal ligament.


METHODS
Retrospective study of medical records.


METHODS
University department of surgery.


METHODS
8 patients admitted after accidents (road traffic accidents, n = 4; falls, n = 2; and gunshot and stab wounds, n = 1 each) who were found at laparotomy to have injuries of the structures of the hepatoduodenal ligament.


METHODS
Laparotomy in all cases.


METHODS
Morbidity and mortality.


RESULTS
One patient died (13%) of multiple organ failure after a gunshot wound of the portal vein, liver, inferior vena cava, right renal artery, and right kidney. All patients had associated injuries. There were 3 complete transsections of the common bile duct, two of which were treated by Roux-en-Y cholecystojejunostomy and one by choledochojejunostomy over a T tube. Two lacerations of the common hepatic duct were treated by T tube choledochostomy. All injuries to blood vessels were sutured. Only one patient survived without any complications, and two developed cholangitis after cholecystojejunostomy that required further operation 5 and 16 months after the initial operation.


CONCLUSIONS
Blunt injuries to the hepatoduodenal ligament are easily overlooked, leading to delayed morbidity. Complete transsections of the bile duct are best managed by choledochojejunostomy with a Roux-en-Y loop; T tube choledochostomy is usually sufficient when treating small partial lesions of lobar bile ducts; and most non-circumferential vascular lesions are best treated by suture.
Leppäniemi
A K
AK
Second Department of Surgery, Helsinki University Central Hospital, Finland.
Jokelainen
O S
OS
Haapiainen
R K
RK
D000059:Accidents; D000293:Adolescent; D000328:Adult; D000368:Aged; D017734:Bile Ducts, Extrahepatic / Q000293:injuries* / Q000601:surgery; D005260:Female; D006499:Hepatic Artery / Q000293:injuries* / Q000601:surgery; D006801:Humans; D007432:Intraoperative Period; D008297:Male; D008875:Middle Aged; D009104:Multiple Trauma / Q000175:diagnosis / Q000601:surgery*; D010537:Peritoneum / Q000293:injuries* / Q000601:surgery*; D011169:Portal Vein / Q000293:injuries* / Q000601:surgery; D011183:Postoperative Complications; D012189:Retrospective Studies; D014949:Wounds, Nonpenetrating / Q000175:diagnosis / Q000601:surgery*; D014950:Wounds, Penetrating / Q000175:diagnosis / Q000601:surgery*