Abstract
Vascular injuries of the porta hepatis possess the unfavorable combination of being both rare and life threatening. Reported experience from different institutions is similar with respect to the fact that they comprise small case series over relatively long intervals of time, reflecting the infrequency with which one encounters these injuries. Associated mortality rates have been reported between 40 and 70 %, and death is most commonly a result of exsanguination. A potentially lethal injury that is seldom encountered should give the trauma surgeon pause, and the importance of having a preestablished management strategy in mind must be emphasized. In this chapter, we will provide an overview of the relevant anatomy and physiology, techniques for hemorrhage control and operative exposure, and a strategy for the definitive management of portal vein and hepatic artery injuries.