Penetrating liver laceration with complete transection of hilar structures presenting with minimal clinical signs.

A 42-year old man with a penetrating laceration of the right liver lobe with complete transection of the right hepatic artery, right portal vein and left hepatic duct presented with minimal clinical signs and haemorrhage. Selective coeliac angiography and computer tomography (CT) revealed the vascular injuries. Forty-three hours after hospital admission the patient underwent right hepatectomy and bilioenteric anastomosis of the transected left bile duct to a Roux-en-Y segment of upper jejunum without stenting. Abscess formation and thrombosis of the inferior caval vein complicated recovery, but the patient was discharged from the hospital six weeks after this major hepatic injury, which usually presents with an exsanguinating massive haemorrhage.