Ahmed Nurhussen Mossa, Aki Belete Shikuro, Demeke Dawit Argaw, Ahmed Sitotaw Mossa
Yekatit 12 Hospital Medical College, department of surgery, Addis Ababa, Ethiopia.
ALERT comprehensive specialized Hospital, department of surgery, Addis Ababa, Ethiopia.
Int J Surg Case Rep. 2025 Jan;126:110685. doi: 10.1016/j.ijscr.2024.110685. Epub 2024 Nov 28.
Traumatic injuries of the inferior Vena Cava (IVC) are rare among traumatic abdominal injuries. It accounts for fewer than 5 % of penetrating injuries and 0.5 % of blunt trauma injuries. Inferior vena cava injury has high Prehospital (30 % -50 %) and in-hospital (20 % - 66 %) mortality rates. Preoperative diagnosis of IVC injury is extremely difficult. Ligation, primary suture repair (venorrhaphy) and patch cavaplasty are among the management options for Inferior vena cava injury. Inferior vena cava injuries are rare and information is scarce especially in resource limited setups.
A 22 years old female presented with right upper quadrant abdominal stab injury of 30 min duration. She was hypotensive and there was 3 × 2 cm right upper quadrant stab wound with breach of parietal peritoneum. The intraoperative finding was gallbladder perforation .duodenum through-through injury and suprarenal inferior vena cava 3 cm vertical laceration. Cholecystectomy, duodenal repair and direct suture repair (venorrhaphy) of IVC done. Post operatively patient had smooth course and discharged on her 9th pod day.
The most frequently injured segment of the IVC is the infra-renal IVC (39 %), then the retro-hepatic IVC (19 %), the supra-renal IVC (18 %), the para-renal IVC (17 %) and the supra-hepatic IVC (7 %). The suprahepatic IVC has the highest mortality rate (100 %), followed by mortality rates of the retro hepatic IVC (78 %), juxtarenal IVC (50 %), suprarenal IVC (33 %), and infrarenal IVC (33 %). Operative management includes ligation, primary suture repair (venorrhaphy) and patch cavaplasty using saphenous vein graft, autogenously peritoneo-fascial (APF) graft, synthetic graft such as Gore-Tex and Dacron.
Traumatic injury of the inferior Vena Cava is rare, however the mortality rate is high. Adequate resuscitation and early hemorrhage control (operation) can save the lives of IVC injured patients. We present a case of successful repair of IVC injury by venorrhaphy (suture repair) in a resource limited setup.
下腔静脉（IVC）创伤性损伤在腹部创伤中较为罕见。在穿透伤中占比不到5%，在钝性创伤中占比0.5%。下腔静脉损伤的院前死亡率（30% - 50%）和院内死亡率（20% - 66%）都很高。术前诊断下腔静脉损伤极其困难。结扎、一期缝合修复（静脉缝合术）和补片腔静脉成形术是下腔静脉损伤的治疗选择。下腔静脉损伤很罕见，尤其是在资源有限的环境中，相关信息匮乏。
一名22岁女性因右上腹刺伤30分钟前来就诊。她血压低，右上腹有一个3×2厘米的刺伤伤口，腹膜破损。术中发现胆囊穿孔、十二指肠贯通伤以及肾上段下腔静脉3厘米的垂直撕裂伤。进行了胆囊切除术、十二指肠修复术以及下腔静脉直接缝合修复（静脉缝合术）。术后患者恢复顺利，术后第9天出院。
下腔静脉最常受伤的节段是肾下段下腔静脉（39%），其次是肝后段下腔静脉（19%）、肾上段下腔静脉（18%）、肾旁段下腔静脉（17%）和肝上段下腔静脉（7%）。肝上段下腔静脉的死亡率最高（100%），其次是肝后段下腔静脉（78%）、肾周段下腔静脉（50%）、肾上段下腔静脉（33%）和肾下段下腔静脉（33%）。手术治疗包括结扎、一期缝合修复（静脉缝合术）以及使用大隐静脉移植物、自体腹膜筋膜（APF）移植物、合成移植物如戈尔特斯（Gore-Tex）和涤纶进行补片腔静脉成形术。
下腔静脉创伤性损伤罕见，但死亡率高。充分的复苏和早期出血控制（手术）可以挽救下腔静脉损伤患者的生命。我们报告了一例在资源有限的环境中通过静脉缝合术（缝合修复）成功修复下腔静脉损伤的病例。
