Why is treating hepatic vein injuries so difficult?

Question

I've read a few ER room stories on quora where trauma surgeons would dictate their real life accounts.

One of them said about a accident victim who was very much alive , conscious and talkative. Upon operating the surgeon's team found that the hepatic vein has ruptured from vena cava behind the liver. So the team decided that nothing could be done to repair that damage and save the patient's life. They stopped the life support and slowly the patient died on the table.

Full account of the incident here

Reading through the comments I found this passage : You remember Professor Asrat used to say that injuries to the vena cava behind the liver are when the surgeon sees God? He used to say things like that that I didn’t understand. I understand now.’”

What I fail to understand is why was this situation deemed untreatable? Especially when someone is very much alive.

Why would one not try to treat it anyway regardless of success rate when the other option is definitely death of the patient?

Several cases which are very likely to be fatal (cancer , HIV , ebola ) etc are treated regardless of the final outcome so what went wrong in this case?

Answer 1

The part of the question about passive euthanasia is an ethical question, which in my opinion does not fit for Health.SE.

From INJURY SEVERITY SCORING:

a Hepatic avulsion, which is given with vein has ruptured from vena cava, has an ABBREVIATED INJURY SCALE of 6 which would count as unsurvivable.
Problems with the surgical treatment are in addition to the high blood loss:

• Venous walls are very delicate, so that a sewing, especially at irregular torn ends, is difficult.
• Ingress of air into open veins may result in pulmonary embolism.
• Disrupted blood flow can lead to the formation of thrombi which can also end in a pulmonary embolism or can lead to congestion of the arterial inflow in the liver and thus to liver failure or further bleeding.