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A hemodynamically unstable seventeen-year old male is brought to the emergency department after being shot. Entrance and exit wounds are in the substernal and right paraspinal area, respectively. Resuscitation through two upper extremity intravenous catheters is initiated. In the operating room a moderate amount of free peritoneal blood is encountered. There is a wound on the anterior surface of the liver and a nonpulsatile expanding hematoma is found in the retrohepatic space.
The best initial intraoperative management of this suspected retrohepatic vena caval injury is
A packing.
B intracaval shunt.
C ligation of the suprahepatic vena cava in the chest.
D Pringle maneuver (i.e. occlusion of the hepaticoduodenal ligament).
E hepatotomy along the bullet track.
A hemodynamically unstable seventeen-year old male is brought to the emergency department after being shot. Entrance and exit wounds are in the substernal and right paraspinal area, respectively. Resuscitation through two upper extremity intravenous catheters is initiated. In the operating room a moderate amount of free peritoneal blood is encountered. There is a wound on the anterior surface of the liver and a nonpulsatile expanding hematoma is found in the retrohepatic space.
The best initial intraoperative management of this suspected retrohepatic vena caval injury is
A packing.
B intracaval shunt.
C ligation of the suprahepatic vena cava in the chest.
D Pringle maneuver (i.e. occlusion of the hepaticoduodenal ligament).
E hepatotomy along the bullet track.
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