A 17-year-old male patient, who was operated at an external center due to a motorcycle accident and underwent two surgical interventions in two days, was referred to our department due to his hemorrhage, which continued despite the packing and liver parenchymal suturation. After resuscitation and preparation of the necessary blood products in the intensive care unit, he was taken into emergency surgery. During exploration, a Grade V liver laceration associated with major hepatic venous injury was detected, involving segments VI, VII and VIII of the liver. During the examination, a laceration of approximately 10×8 mm in size was detected at the junction of the hepatic vein and inferior vena cava, a large wall defect of approximately 30×18 mm in the right hepatic vein, and laceration areas of 3–4 mm in diameter in three separate regions of the inferior vena cava. Vascular injuries were primarily repaired and after bleeding control was achieved, the operation was terminated by repacking in accordance with the principles of damage control surgery. Postoperative damage control surgery was performed 24 hours later, no active bleeding areas were detected, propofol was administered from the gallbladder to detect bile leaks, and bile duct repair and omentopexy were performed with the omentum.

A five minute video of the highlights of this remarkable operation is attached below.

https://drive.google.com/file/d/1wNVs6hee0rhxnJ-m4PntJjx6Exntbp-2/view?usp=sharing