Case Report A 30-year-old male knife collector with a history of depression was taken directly to the OR without X-rays after suffering a self-inflicted right upper quadrant abdominal stab wound with a samurai sword and presenting to a level 1 trauma center with hypotension and peritonitis. A Pringle maneuver with a vascular clamp controlled bleeding from the hepatoduodenal ligament. After proximal and distal vascular control with silastic tapes, a 10 mm longitudinal right hepatic arterial injury was repaired with 5-0 prolene suture and a cholecystectomy was performed (Figs. 1 and 2). An intraoperative cholangiogram demonstrated an intact common bile duct. The patient made a full recovery. Any patient with a penetrating abdominal wound and a history of hypotension in the field or ED should be suspected of having an abdominal vascular injury. An agonal patient with a penetrating abdominal wound and a massively distended abdomen almost always has an abdominal vascular or combined hepatic-vascular injury. The trauma team may need to perform a left anterolateral thoracotomy with cross-clamping of the descending thoracic aorta before transfer to the OR. The patient is moved to the OR without X-ray evaluation. If exsanguination is suspected from an injury in the region of the porta hepatis, then a Pringle maneuver using vascular clamps will often allow the structures in the area to be dissected out to determine whether the injury involves the portal vein, hepatic arteries, extra-hepatic ducts, or a combination of structures. Of the 21 patients in Busuttil's report of blunt and penetrating porta hepatis injuries, 18 had severe associated trauma with injury to more than one structure of the porta hepatis or to other abdominal organs.2 Hepatic and pancreatic injuries comprised the predominant associated injury, occurring in 62 and 29 per cent of patients, respectively. Concomitant aortic or vena caval injuries were found in 24 per cent of patients.
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