Abstract text (incl. references and figure legends)
Case history A 30-year-old male presented to our emergency department after a stab wound with knife on right lower chest.
Clinical findings The patient was in hypovolemic shock with the blood pressure of 90/60 mmHg, weak peripheral pulses at the rate of 110 per minute, An entry wound was observed on on right lateral axillary line.
Investigation/Results Focused Assessment with Sonography for Trauma(FAST) was positive for free fluid in perihepatic area, Abdomianl CT findings showed penestrating wound in upper segment of right hepapatic lobe with arterial extravasation and the wound extended to suprahepatic IVC.
Diagnosis Right hepatic and suprahepac IVC injury.
Therapy and Progressions Transcatheter arterial embolization(TAE) was conducted to stop active bleeding from right hepatic artery. Then emergency operation was performed. Diaphragm, hepatic injury and the confluence of the IVC and the right atrium injury were repaired. Damage control surgery was performed with perihepatic packing and placed temporary abdominal closure dressing. The second-look laparotomy performed 36 h after the first surgery. The postoperative course was uneventful.
Comments Injury to the supra-hepatic IVC is very rare and challenging to treat with high motality. Multiple factors have contributed to the patient"s favorable outcome, including rapid transfer and trauma response, relatively good health prior to injury and mutidisplinary therapeutic approach. Timely intervention and damage control surgery can stabilize and save these patients.
References Predictors of Mortality in Patients with Penetrating Inferior Vena Cava Injuries Surviving to the Operating Room. Maciel JD, Plurad D, Gifford E, deVirgilio C, Koopmann M, Neville A, Putnam B, Kim DY. Am Surg. 2015 Oct;81(10):1000-4.
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