Management of Inferior vena cava injury in a resource limited setup: A rare case report.

INTRODUCTION AND IMPORTANCE

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.

CASE PRESENTATION

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.

CLINICAL DISCUSSION

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.

CONCLUSION

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.