A Case of Traumatic Injury of the Retrohepatic Inferior Vena Cava with Severe Liver Rupture

Shiro Furutani, Noriyuki Oomori, Shigeo Imai, Hisashi Tsuji, Shunji Kawakami, Kensaku Ono, Koukichi Ootsuka, Yasuo Sato

Department of Surgery, Okayama Red Cross Hospital

A patient who suffered severe liver rupture accompanied by injuries of the retrohepatic inferior vena cava was successfully treated by right lobectomy and suturing of the injuries. The patient was a 20-year-old woman who was transported to us after a traffic accident. She went into shock 2 hours after the accident, and an emergency operation was carried out 6 hours after the injury. Rupture of the right hepatic lobe was observed. Since hemorrhage could be reduced by manual compression, the right lobe was resectd after portal triad occlusion. The right hepatic vein was completely separated, and a wound about 1.5 cm long was observed at 2 sites in the retrohepatic inferior vena cava. Each of these lesions was closd by continuous suture, and hemostasis was achieved. The operative field was filled with CO₂ to prevent air embolism. The survival rate after liver rupture with injury of the inferior vena cava is poor. However, temporary hemostasis by simulutaneus application of the Pringle maneuver and manual compression, followed by partial hepatectomy and suturing of vena caval injuries after restoration of the hemodynamics is considered to increase the chance of control of massive hemorrhage and survival of the patient. Filling the operative filed with CO₂ is effective for prevention of air embolism.

Key words
liver injury, retrohepatic inferior vena cava injury, air embolism of inferior vena cava

Reprint requests
Shiro Furutani Department of Surgery, Okayama Red Cross Hospital
65-1 Aoe, Okayama, 700 JAPAN

Accepted
June 17, 1992

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