Carmona MVH, Retana MFJ, Espinosa MA, Plascencia MG

Language: Spanish
References: 11
Page: 193-197
PDF size: 83.95 Kb.

ABSTRACT

Objective: To describe a case of supradiaphragmatic inferior vena cava injury due to penetrating chest trauma.
Design: Report on a case.
Setting: Second health care level hospital.
Description of the case: Man of 25 years, who was attacked 6 hours before his admittance to the emergency ward, with a sharp-cutting instrument at the level of the right hemithorax. He was in hypovolemic shock at admittance. Arterial pressure of 60/30 mmHg, cardiac frequency of 120/min, respiratory frequency 28/min, wound in the right thorax of approximately 1.5 cm at the level of the 7^th intercostal space, clavicular midline, ipsilateral hypoventilation. X-rays revealed right hemothorax, an endopleural catheter was inserted, draining 3,000 cm³ of blood at the time of placement. He was taken to surgery, a right anterolateral thoracotomy was performed finding 1,000 cm³ of blood, injury of the inferior cava vein at the level of the cava’s hiatus of approximately 2 cm, the incision was widened to the abdominal midline, the infrarenal inferior vena cava was clamped and the supradiaphragmatic inferior vena cava was clamped at its mouthing into the right atrium The diaphragm was sectioned to improve exposure of the injury, and repaired with silk 3-0. Two endopleural catheters were inserted, the anterior and posterior: thoracic and abdominal cavity was closed conventionally. He required 72 hours of intensive care, he was returned to the operating room without complications.
Conclusion: Injuries to the supradiaphragmatic inferior vena cava are scarce mainly due to the central position of the vein, which protects it from aggressions, aside from its short length at this level. This type of injury carries a high mortality and requires and adequate surgical approach and adequate exposure of the injury for its repair. Surgical management must be started immediately after a vigorous and fast resuscitation in the emergency room.

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