A Case of Survival from the Injury of the Retrohepatic Inferior Vena Cava Accompanied by Severe Liver Rupture

• Published in: Japanese Journal of National Medical Services Vol. 41; no. 1; pp. 64 - 67
• Main Authors: KUROKI, Nobuyoshi, OKAZAKI, Yoshio, MII, Toshiaki, NAGATA, Takayoshi
• Format: Journal Article
• Language: Japanese
• Published: Japanese Society of National Medical Services 1987
• ISSN: 0021-1699; 1884-8729
• DOI: 10.11261/iryo1946.41.64

Injury to the inferior vena cava as a result of blunt trauma of the abdomen is one of the most intractable lesions. The mortality from this injury is reported to be as high as 80 to 90%. Injury to the retrohepatic inferior vena cava results in a more higher mortality. Only a few cases of survival from this injury have been reported in Japan. This report is a rare case of survival from the injury of the retrohepatic inferior vena cava accompanied by severe liver rupture. A four-year-old girl was involved in a traffic accident and her abdomen was injured. She was admitted to our hospital in a state of shock about 1 hour after the injury. Severe anemia was present on admission, so that her blood pressure was hardly measurable. However, shock-alleviating therapy (such as blood transfusoon) could improve her general condition. A CT-scan on the abdomen revealed liver rupture resulting in intraperitoneal hemorrhage. The patient immediately underwent an operation. Pathological findings were crush and rupture in a wide range of the right hepatic lobe along the right hepatic vein and injury at 3 sites (5 to 10mm each) of the retrohepatic inferior vena cava. Since transient hemostasis in the inferior vena cava could be successfully achieved by the use of exclusion clamps, the right hepatic lobe was excised. After that, the inferior vena cava was completely blocked at the suprarenal and infrahepatic sites. The operation was finished with suture of the injury of the inferior vena cava. The patient recovered from the injury and discharged from the hospital on the 31st postoperative day. Success in this treatment was attained under the following favorable conditions: (1) The patient was admitted to the hospital shortly after the injury. (2) The patient could transiently recover from shock after blood transfusion and other appropriate treatments. (3) The inferior vena cava could be easily reached with no need to excise and mobilize the liver due to severe liver rupture. (4) Transient hemostasis in the inferior vena cava was possible with the use of exclusion clamps. (5) No injury was present in any other organs except the liver. (6) The operation was easily performed because the patient was a child.