During emergency laparotomy for a penetrating liver injury with massive haemorrhage, the surgeon applies a Pringle manoeuvre but bleeding from the liver wound persists undiminished. This persistent bleeding indicates that the source is most likely:

• A Hepatic arterial inflow
• B Portal venous inflow
• C Coagulopathy alone
• D Retrograde bleeding from hepatic veins or the retrohepatic vena cava ✓

Explanation

The Pringle manoeuvre occludes the hepatic artery and portal vein within the free edge of the lesser omentum and therefore controls all inflow bleeding. If bleeding continues despite effective clamping, the source must be backflow from the hepatic veins or retrohepatic inferior vena cava, which lies outside the porta hepatis and cannot be compressed by the clamp. Such injuries demand vascular isolation, atriocaval shunting, or damage-control packing rather than further inflow control.

Reference: Bailey and Love's Short Practice of Surgery, 27th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.