A Case of Traumatic Injury of the Retrohepatic Inferior Vena Cava with Severe Liver Rupture.

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A patient who suffered severe liver rupture accompanied by injuries of the retrohepatic inferior vena cava was successfully treated by right lobectomy and suturing of the injuries. The patient was a 20-year-old woman who was transported to us after a traffic accident. She went into shock 2 hours after the accident, and an emergency operation was carried out 6 hours after the injury. Rupture of the right hepatic lobe was observed. Since hemorrhage could be reduced by manual compression, the right lobe was resected after portal triad occlusion. The right hepatic vein was completely separated, and a wound about 1.5cm long was observed at 2 sites in the retrohepatic inferior vena cava. Each of these lesions was closed by continuous suture, and hemostasis was achieved. The operative field was filled with CO<SUB>2</SUB> to prevent air embolism. The survival rate after liver rupture with injury of the inferior vena cava is poor. However, temporary hemostasis by simulutaneus application of the Pringle maneuver and manual compression, followed by partial hepatectomy and suturing of vena caval injuries after restoration of the hemodynamics is considered to increase the chance of control of massive hemorrhage and survival of the patient. Filling the operative filed with CO<SUB>2</SUB> is effective for prevention of air embolism.
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