What is it about?

We present the case of a 22-year-old man transferred to the regional major trauma centre following a fall of approximately 15 meters. 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 litres 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. This case describes an unusual finding at re-laparotomy and shows that even when there is no active bleeding from abdominal organs or classified vessels, it is possible to have isolated injury to the ​proper hepatic artery.

Featured Image

Why is it important?

We disseminate three messages. First, to the operating surgeon: be vigilant and more aggressive having in hand and palpating bruised but not bleeding hepatoduodenal ligament (a bruised hepatoduodenal ligament should be considered for surgical exploration as it can conceal substantiate bleeding). Second, to the trauma radiologist and trauma medical director: precision radiological assessment and closely monitored non-invasive cardiac output monitoring in the trauma ward are of paramount importance. Third: to provide a case-based mini-handbook to all.


The section 'Patient's perspective' is most important for me. It is a must-read​ paragraph.

Mr Raimundas Lunevicius
University of Liverpool

Read the Original

This page is a summary of: Traumatic bruising of the hepatoduodenal ligament can conceal a catastrophic injury to the hepatic artery, BMJ Case Reports, September 2019, BMJ, DOI: 10.1136/bcr-2019-230706.
You can read the full text:



The following have contributed to this page