Gerrard Adam Daniel, Lunevicius Raimundas, Heavey Nicholas
Department of General Surgery, Aintree University Hospital NHS Foundation Trust, Liverpool, UK.
School of Medicine, University of Liverpool, Liverpool, UK.
BMJ Case Rep. 2019 Sep 18;12(9):e230706. doi: 10.1136/bcr-2019-230706.
We present the case of a 22-year-old man transferred to the regional major trauma centre following a fall of ~15 m. He remained consistently haemodynamically stable for over 10 hours of observation until he deteriorated suddenly with major haemorrhagic shock requiring immediate trauma laparotomy. At laparotomy, 2 L of blood was drained from the abdomen but no source of active bleeding identified. 30 minutes after closure of the abdomen, 500 mL of fresh blood was noted in the drain so he was returned to the theatre where the bleeding source was found to be-after manual compression of a mildly bruised hepatoduodenal ligament-the proper hepatic artery (PHA). This case describes an unusual finding at relaparotomy and shows that even when there is no active bleeding from abdominal organs or classified vessels, it is possible to have isolated injury to PHA.
我们报告一例22岁男性患者，其在坠楼约15米后被转送至区域重大创伤中心。在超过10小时的观察期内，他的血流动力学一直保持稳定，直到突然病情恶化，出现严重失血性休克，需要立即进行创伤性剖腹手术。剖腹手术时，从腹腔引出了2升血液，但未发现活动性出血源。腹部缝合30分钟后，引流管中出现了500毫升新鲜血液，因此他被送回手术室，在那里发现出血源是——在对轻度瘀伤的肝十二指肠韧带进行手动压迫后——肝固有动脉（PHA）。本病例描述了再次剖腹手术时的一个不寻常发现，并表明即使腹部器官或分类血管没有活动性出血，肝固有动脉也可能出现孤立性损伤。
