Duodenal and inferior vena cava injury secondary to penetrating trauma. About a case

Abstract text (incl. references and figure legends)

INTRODUCTION

The inferior vena cava (IVC) is the most frequently associated vascular lesions due to penetrating trauma, representing the 30-40% of all intra-abdominal vascular injuries. On the other hand, the incidence of duodenal injury rate is 3'7-5%.

MATERAL & METHODS

The objective is to present a case of a 58-year-old male patient with duodenal and inferior vena cava (IVC) injury, and its surgical management.

RESULTS

We present a 58-year-old man with an attempted suicide with a cold weapon. The airway was patent. Blood pressure was 125/70mmHg, with normal heart rate. Glasgow 15/15. On examination, he presented a 4-cm-long incisional lesion with an adherent clot in the epigastrium, without abdominal pain. A CT scan is performed, revealing penetrating abdominal trauma with signs of duodenal perforation and hemoperitoneum (Image 1). Urgent surgical intervention was decided, objectifying a large retroperitoneal hematoma and perforation in the anterior and posterior face of both the duodenal knee and the inferior vena cava (Image 2). A Cattell Braasch maneuver was performed and the retroperitoneal hematoma was opened. After distal and proximal vascular control, the duodenal perforation and the IVC was sutured. Subsequently, he presented good clinical evolution, being discharged on the 6th postoperative day.

CONCLUSIONS

Traumatic retroperitoneal injuries usually occur in the context of a trauma patient with multiple associated injuries. The most frequent symptoms are pain and abdominal distension, although up to 8% of patients remain asymptomatic. In hemodynamically stable patients, the use of CT with oral and intravenous contrast stands out. The Cattle-Braasch maneuver facilitates the evaluation on the portal vein and IVC, in addition to the visualization of the 4 duodenal portions.  The most commonly adopted strategies to deal with penetrating IVC injuries are caval ligation and venorrhaphy. For duodenal injuries, a primary suture is accepted.

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