Case Report
Copyright ©The Author(s) 2023. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Cases. Jun 6, 2023; 11(16): 3837-3846
Published online Jun 6, 2023. doi: 10.12998/wjcc.v11.i16.3837
Severe liver trauma with complex portal and common bile duct avulsion: A case report and review of the literature
Bianca Mitricof, Alin Kraft, Florentina Anton, Alexandru Barcu, Darina Barzan, Carmen Haiducu, Vladislav Brasoveanu, Irinel Popescu, Cosmin Alec Moldovan, Florin Botea
Bianca Mitricof, Alexandru Barcu, Medicine Doctoral School, Titu Maiorescu University of Bucharest, Bucharest 040441, Romania
Alin Kraft, Department of General Surgery, Regina Maria Military Emergency Hospital, Brasov 500007, Romania
Florentina Anton, Faculty of Medicine, Carol Davila University of Medicine and Pharmacy, Bucharest 050474, Romania
Darina Barzan, Carmen Haiducu, Vladislav Brasoveanu, Irinel Popescu, Florin Botea, Dan Setlacec Center for General Surgery and Liver Transplant, Fundeni Clinical Institute, Bucharest 022328, Romania
Vladislav Brasoveanu, Irinel Popescu, Cosmin Alec Moldovan, Florin Botea, Department of Medical-Surgical and Prophylactic Disciplines, Faculty of Medicine, Titu Maiorescu University of Bucharest, Bucharest 031593, Romania
Cosmin Alec Moldovan, Department of General Surgery, Witting Clinical Hospital, Bucharest 010243, Romania
Author contributions: Mitricof B, Kraft A, Botea F, Moldovan C and Popescu I provided conceptualization; Botea F, Moldovan C and Popescu I designed the methodology and performed validation; Kraft A, Botea F, Moldovan C and Popescu I provided formal analysis; Mitricof B, Kraft A, Anton F, Bârcu A, Bârzan D, Haiducu C and Brașoveanu V were responsible for investigation; Mitricof B, Kraft A, Anton F, Bârcu A, Bârzan D, Haiducu C, Brașoveanu V and Popescu I performed data curation; Mitricof B, Kraft A, Anton F, Bârcu A and Haiducu C provided writing and original draft preparation; Brașoveanu V, Popescu I, Botea F and Moldovan C performed final review and editing; Popescu I and Brașoveanu V were in charge of supervision; Botea F and Moldovan C were responsible for project administration; All authors have read and agreed to the published version of the manuscript.
Informed consent statement: Informed consent was obtained from the subject involved in the study.
Conflict-of-interest statement: All the authors report having no relevant conflicts of interest for this article.
CARE Checklist (2016) statement: The authors have read the CARE Checklist (2016), and the manuscript was prepared and revised according to the CARE Checklist (2016).
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Cosmin Alec Moldovan, MD, PhD, Associate Professor, Department of Medical-Surgical and Prophylactic Disciplines, Faculty of Medicine, Titu Maiorescu University of Bucharest, 67A Gheorghe Pătrașcu Street, 031593 Bucharest, Romania. cosmin.moldovan@prof.utm.ro
Received: February 9, 2023
Peer-review started: February 9, 2023
First decision: March 28, 2023
Revised: April 2, 2023
Accepted: April 12, 2023
Article in press: April 12, 2023
Published online: June 6, 2023
Core Tip

Core Tip: This paper analyzes a rare and difficult case of a 38-year-old male patient that presented to the nearest emergency hospital for polytrauma secondary to a crush injury, which mainly resulted in a severe liver trauma associated with vascular and biliary injury (grade V liver trauma with severe laceration involving more than 75% of the right hemiliver with injury of the right portal vein and common bile duct). Its management consisted in emergency damage control surgery for hemostasis by vascular ligation and packing in a primary trauma center. This was followed by a major liver resection (right hepatectomy) and biliary reconstruction in a tertiary hepato-bilio-pancreatic (HBP) center. The patient recovered well with no long-term complications and had a follow-up ultrasound that showed no issues. Currently, the overall survival is 55 mo. In conclusion, the current case clearly supports that a favorable outcome in severe liver trauma with associated vascular and biliary injuries is achieved thru proper therapeutic management, conducted in a tertiary referral HBP center, where stepwise and complex surgical approach is mandatory.