A 35-year-old male with a stab wound on the right upper quadrant of the abdomen just below the costal margin is brought to emergency room with BP 80/50 mm Hg and pulse rate 140/min. FAST reveals blood in Right upper quadrant. Immediately the patient is taken for emergency laparotomy. To stop the bleeding, surgeon tries to occlude the free edge of lesser omentum. However, the bleeding does not stop. Which of the following structure is likely source of haemorrhage?

**Core Concept**
The underlying principle being tested is the knowledge of anatomical structures involved in the control of bleeding in the abdominal cavity, particularly the **hepatic pedicle** and surrounding structures. The **hepatic pedicle** contains the **portal vein**, **hepatic artery**, and **common bile duct**.

**Why the Correct Answer is Right**
The **free edge of lesser omentum** (also known as the **hepatoduodenal ligament**) contains the **portal triad**. If occluding this area does not stop the bleeding, it suggests the source of hemorrhage is not the **hepatic artery** or **portal vein** within the **hepatic pedicle**. Instead, the bleeding might be coming from a nearby structure that is not controlled by occlusion of the **hepatoduodenal ligament**.

**Why Each Wrong Option is Incorrect**
**Option A:** This choice is incorrect because occluding the **free edge of lesser omentum** should control bleeding from the **hepatic artery** if it is the source.
**Option B:** Similarly, this choice would be controlled by occlusion of the **hepatoduodenal ligament**.
**Option C:** This option might seem plausible but given the context, it's less likely to be the correct choice without further specification.

**Clinical Pearl / High-Yield Fact**
In cases of severe abdominal trauma with suspected hepatic injury, the **Pringle maneuver** (occluding the **free edge of lesser omentum**) can be used to temporarily control bleeding from the **liver** by stopping flow through the **hepatic artery** and **portal vein**. If this maneuver does not stop the bleeding, it may indicate bleeding from other sources such as the **inferior vena cava** or **hepatic veins**.

**Correct Answer:** D. Hepatic vein

✓ Correct Answer: D. Inferior vena cava