Hepatobiliary and pancreatic surgery: Pringle manoeuvre: practice question

A General Surgery question in the style of the NEET PG paper. Answer it first, then read why the right option is right and why each of the others is wrong.

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General Surgery · Hepatobiliary and pancreatic surgery: Pringle manoeuvre

Sample item

During laparotomy for blunt liver trauma, the surgeon clamps the hepatoduodenal ligament, but dark, steady bleeding continues from behind the liver. Which injury is most likely?

AMain portal veinBLeft hepatic arteryCRight hepatic arteryDRetrohepatic vena cava or hepatic vein

Original practice item, not a recalled exam question. Nothing here is recorded.

The answer and the reasoning

D. Retrohepatic vena cava or hepatic vein

The Pringle manoeuvre occludes the hepatic artery and portal vein in the hepatoduodenal ligament, controlling inflow. Bleeding that persists points to outflow injury from the hepatic veins or retrohepatic inferior vena cava, which is hard to control and carries a high mortality.

Option by option

A. Main portal vein
The portal vein is occluded by the clamp, so bleeding from it should stop.
B. Left hepatic artery
The left hepatic artery is also inside the ligament and is controlled by the clamp.
C. Right hepatic artery
The right hepatic artery runs in the clamped ligament, so its bleeding should stop.
D. Retrohepatic vena cava or hepatic vein (correct)
Correct. Venous outflow bleeding is not controlled by clamping the inflow.

Source note: Original NextPrep sample item — pending expert review. This item is original practice material awaiting independent expert review, so confirm important facts in a standard textbook.

Questions about this General Surgery question

What is the answer to this General Surgery question?

The best answer is D, Retrohepatic vena cava or hepatic vein. The Pringle manoeuvre occludes the hepatic artery and portal vein in the hepatoduodenal ligament, controlling inflow.

Why is "Main portal vein" not the answer?

The portal vein is occluded by the clamp, so bleeding from it should stop.

Why is "Left hepatic artery" not the answer?

The left hepatic artery is also inside the ligament and is controlled by the clamp.

Why is "Right hepatic artery" not the answer?

The right hepatic artery runs in the clamped ligament, so its bleeding should stop.

What concept does this question test?

It tests Hepatobiliary and pancreatic surgery: Pringle manoeuvre in General Surgery. Bleeding that persists points to outflow injury from the hepatic veins or retrohepatic inferior vena cava, which is hard to control and carries a high mortality.

How hard is this question?

We tag it as a multi-step question: it asks you to combine more than one idea. The tag is our own editorial judgement, not an official difficulty rating, so read the reason for every option, not only the answer.

How should I study Hepatobiliary and pancreatic surgery: Pringle manoeuvre?

Learn classic signs and eponyms alongside what they diagnose. Then use the flashcards and the other General Surgery questions on this site to test what stuck.

Is this a real NEET PG question?

No. It is an original practice item (editorial status: sample, version 1). NextPrep does not publish recalled or leaked questions, and independent faculty review of this item has not been completed yet, so confirm important facts in a standard textbook.