Inferior vena cava injury after blunt trauma: Case report

Abstract

Highlights Inferior vena cava injury is a rare injury with high rate mortality. Few clinical cases have described the clinical findings and radiologic appearance of this kind of injury. We describe a rare clinical case of inferior vena cava hematoma. The management depends on the hemodynamic stability of the patient and the level of injury, it might be surgical, endoscopic.

Blunt inferior vena cava injury associated with AAST-grade V hepatic and renal injuries: A case report

“…The survival of injury to the IVC is determined by the three main factors: the major vessel injury, the level of IVC injury, and any active bleeding during surgery [2] . The main cause of death is due to uncontrollable intraoperative hemorrhage [1] . All the three factors were present in our cases, so-called laceration of the right main renal vein, injury of the higher levels of IVC (suprahepatic and suprarenal segments), and active bleeding from the liver laceration and the major vessels which caused massive hemoperitoneum and retroperitoneal hematoma.…”

“…Hemodynamic ally unstable patients in the setting of the major vascular injury need emergent laparotomy [2] . Contrast-enhanced CT of the chest and abdomen is reserved for the patients in hemodynamic ally stable condition, and is the gold standard for the evaluation of the patients with IVC injury and associated other chest and intraabdominal injuries including rib and spine fractures [1]. The CT signs for traumatic IVC injuries include active extravasation of contrast medium, retroperitoneal hematoma, IVC contour abnormality, intimal flap or thrombosis, intracaval fat, and hemoperitoneum [2] .…”

“…In the case presented here, the contour irregularity and the adjacent retroperitoneal hematoma are the only CT signs of the IVC injury. Surgical repair of IVC is needed for IVC injury [1,3] . In case of severe IVC injury, ligation of the IVC may be considered.…”

“…Traumatic inferior vena cava (IVC) injury is rare, occurring in 0.5-5% and 1% of penetrating and blunt abdominal trauma respectively [1] . IVC injuries have a grave prognosis, with mortality rates ranging from 34% to 70% [2] .…”

“…Prompt surgical intervention and bleeding control to lower shock period are imperative for improving the survival rate [4] . Contrast-enhanced computed tomography (CT) is the gold standard to evaluate the hemodynamic ally stable patients for the level of IVC injury and injuries to the other vessels and organs [1,3] . Herein, we present a case of major trauma in a 56-year-old female patient experiencing CT-diagnosed suprarenal and retro hepatic IVC injury, grade V hepatic injury, and grade V renal injury involving tear of the right main renal vein according to the American Association for the Surgery of Trauma (AAST) [5] .…”