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RETROHEPATIC VENA CAVA INJURY REMAINS A CHALLENGE TO TRAUMA SURGEONS
Author(s) -
Collet e Silva F. S.,
Bardella R.,
Porta R. M.,
Poggetti R. S.,
Birolini D.
Publication year - 2007
Publication title -
anz journal of surgery
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.426
H-Index - 70
eISSN - 1445-2197
pISSN - 1445-1433
DOI - 10.1111/j.1445-2197.2007.04133_3.x
Subject(s) - medicine , surgery , blunt , mortality rate , damage control , vena cava , fibrous joint , injury severity score , penetrating trauma , inferior vena cava , injury prevention , poison control , emergency medicine
Although uncommon, and despite the modern in diagnostic tools and therapeutic alternatives, retrohepatic and main hepatic veins injury remains associated with high mortality rate. Preoperative diagnosis is uncommon, and bullet trajectory may be a helpful sign in penetrating trauma patients. Patients and Methods Hospital records of patients sustaining retroheptic vena cava (RHVC) injury were retrospectively reviewed as to diagnosis, associated injuries, injury characteristics, surgical management, and outcome, last ten years. Results Eight male, 17 to 45 (mean 27.5) years‐old patients sustaining RHVC injury were reviewed. Mean trauma indexes for the 8 cases were: ISS 36.6, RTS 7.55 and TRISS 89.0; and for the group who died: ISS 41.6, RTS 7.18, and TRISS 80.5. Two patients had sustained blunt trauma (one died), and six had penetrating injuries (two died). The injury diagnosis was achieved during surgery in all cases. A transfixing RHV injury occurred in 4 (50% of the) patients, and was found in all the 3 patients who died. An atriocaval shunt was employed in four patients, 3 of them had with transfixing injury with two deaths. The number of associated injuries was higher in the patients who died. Overall mortality rate was 37.5%. Comments Despite advances in image diagnosis, injuries to RHVC are frequently diagnosed during surgery. Tangential injuries were managed with direct approach and sutures, and to control blending in transfixing injuries, were managed with atriocaval shunts, before suture. Conclusion Despite improvements in its diagnosis and management, RHVC injuries remain with a high mortality rate, mainly when transfixing, and associated with numerous associated injuries.