Complete parenchymal separation of the left hepatic lobe with intact vascular pedicle after blunt trauma: A rare salvageable American Association for the Surgery of Trauma (AAST) Grade V injury

The liver is protected by and firmly adhered to the thoracoabdominal wall via strong ligaments, yet it’s the most commonly injured solid organ in blunt force trauma. The pattern of blunt liver trauma is closely related to the characteristics of the blunt force. We present a unique case of liver injury caused by inertial force. The left lobe was separated from the rest of the liver along the falciform ligament and displaced and rotated to an ectopic position. However, the vascularity of that lobe was intact. Although the patient was hemodynamically stable, he required operative intervention to save the viable left lobe. We successfully managed the case with orthotopic repositioning of the left lobe. The deep laceration along the falciform ligament caused by inertial force demands great attention, as the left hepatic vein or the left branches of the portal structures may be cut off by the injury. A thorough understanding of the mechanisms behind blunt liver trauma is necessary for successful management outcomes.