A 24-year-old man with a stab wound to the right upper quadrant undergoes exploratory laparotomy. He is found to have a Grade IV hepatic laceration with active haemorrhage. The surgeon performs the Pringle manoeuvre which temporarily controls bleeding. Safe limit of normothermic hepatic inflow occlusion (Pringle) before ischaemic injury is:
- A 10-15 minutes
- B 45 minutes maximum continuous
- C 60 minutes maximum continuous in normal liver
- D 20-30 minutes continuous, or up to 60 minutes with intermittent clamping (15 min on/5 min off) ✓
Explanation
The safe limit for continuous normothermic hepatic inflow occlusion (Pringle manoeuvre) is approximately 20-30 minutes in a normal liver before ischaemia-reperfusion injury causes significant hepatocellular damage. Intermittent Pringle (15 minutes clamp, 5 minutes reperfusion) extends total ischaemia tolerance up to 60 minutes or more with maintained hepatocellular function. Cirrhotic livers tolerate significantly shorter periods (15-20 minutes continuous). In damage control surgery, this guides timing of packing versus definitive repair. Hypothermic perfusion can further extend safe ischaemia time.
Reference: Bailey & Love's Short Practice of Surgery, 27th ed.
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