• A K Leppäniemi, O S Jokelainen, and R K Haapiainen.
• Second Department of Surgery, Helsinki University Central Hospital, Finland.
• Eur J Surg. 1993 Jun 1;159(6-7):351-3.

ObjectiveTo report our experience in the management of accidental injuries to the structures of the hepatoduodenal ligament.DesignRetrospective study of medical records.SettingUniversity department of surgery.Subjects8 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.InterventionsLaparotomy in all cases.Main Outcome MeasuresMorbidity and mortality.ResultsOne 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.ConclusionsBlunt 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.

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