Major Hepatic Hemorrhage with Significant Bleeding Persisting After a Pringle Maneuver

This scenario involves major hepatic hemorrhage in blunt liver trauma where significant bleeding continues despite a Pringle maneuver. Persistent hemorrhage under these circumstances is a critical sign requiring immediate clinical reassessment.

When significant bleeding persists after a Pringle maneuver, juxtahepatic venous injury — involving the retrohepatic vena cava or major hepatic veins — must be suspected. This finding substantially changes the operative approach.

The management strategy in this setting centres on a packing-based approach to achieve rapid hemorrhage control. Direct repair is deliberately avoided in the initial operative phase.