Portal vein injury, while one of the more uncommon forms of trauma, is certainly one of the most lethal forms of trauma. Of the thousands of trauma cases admitted into hospitals each year portal vein injury accounts for far less than 1% of all trauma cases. Most patients with an injury to the portal vein often die of haemorrhage before reaching the hospital. For those patients that can be transported into the operating room, mortality is in the 50% to 70% range. The causes of such high mortality rates are related to the difficulty in controlling haemorrhage and the degree of associated injuries that usually accompany an injury to the portal vein. In the setting of portal vein injuries, the type of trauma either penetrating or blunt affects outcome. According to the literature, survivability nearly doubles when the trauma is from a blunt rather than a penetrating mechanism. There is some controversy related to the “best treatment” of patients with portal vein injuries. The major point of contention is whether ligation or tenorrhaphy should be employed in hemodynamically stable patients. Both surgical techniques are options for controlling portal vein haemorrhage. However, it has been reported by some authors that ligation might be more beneficial in patients that are hemodynamically stable.