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Case Report
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| Combined aortic and inferior vena cava injury | ||||||
| Basem Marcos1, Yomayra Perez2, Jennifer Matarlo3, Jay A Yelon4, Valerie Katz5, Robert V Madlinger6 | ||||||
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1Resident, Department of Surgery, Lincoln Medical and Mental Health, Bronx, New York, USA.
2Research Assistant, Department of Surgery, Lincoln Medical and Mental Health, Bronx, New York, USA. 3Trauma Coordinator, Department of Surgery, Lincoln Medical and Mental Health, Bronx, New York, USA. 4Chairman, Department of Surgery, Lincoln Medical and Mental Health, Bronx, New York, USA. 5Associate Program Director, Department of Surgery, Lincoln Medical and Mental Health, Bronx, New York, USA. 6Director of Trauma Services, Department of Traumatology, Lincoln Medical and Mental Health, Bronx, New York, USA. | ||||||
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| How to cite this article: |
| Marcos B, Perez Y, Matarlo J, Yelon JA, Katz V, Madlinger RV. Combined aortic and inferior vena cava injury. International Journal of Case Reports and Images 2013;4(1):51–54. |
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Abstract
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Introduction:
Combined injuries to the aorta and inferior vena cava are among the most severe traumatic injuries where mortality rates can approach 100%.
Case Report: A 26-year-old male presented with multiple small caliber gunshot wounds to the right upper and lower back, right posterior arm and right gluteal area. He was diagnosed with large retroperitoneal hematoma on computed tomography (CT) scan. He underwent an exploratory laparotomy with exploration of a zone 1 retroperitoneal hematoma. An injury to the inferior vena cava (IVC) at the level of the left renal vein was identified and repaired by lateral venorrhaphy. Massive transfusion protocol (MTP) was activated. The patient was returned back to the operating room few hours later for recurrent bleeding. Aortic injury was identified one centimeter distal to the renal arteries secondary to ruptured pseudoaneurysm. The left renal vein was ligated for exposure. The aortic injury was repaired. The patient was resuscitated postoperatively and was discharged home without major morbidity. Conclusion: Combined inferior vena cava and infrarenal aortic injury carries a mortality of around 73%. All zone 1 retroperitoneal hematomas should be explored, with the exception of venous hematomas of the juxtahepatic vena cava. Mattox maneuver is the ideal exposure for a supramesocolic retroperitoneal hematoma and Cattell-Brash maneuver is used for inframesocolic retroperitoneal hematomas. Zone 1 retroperitoneal hematoma resulting from combined injuries to the inferior vena cava and aorta is highly lethal. Successful management requires early MTP, rapid and aggressive surgical management and application of elective vascular surgery techniques. | |
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Keywords:
Inferior vena cava injury, Aorta injury
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Author Contributions
Basem Marcos – Substantial contributions to conception and design, Acquisition of data, Analysis and interpretation of data, Drafting the article, Revising it critically for important intellectual content, Final approval of the version to be published Yomayra Perez – Analysis and interpretation of data, Revising it critically for important intellectual content, Final approval of the version to be published Jennifer Matarlo – Analysis and interpretation of data, Revising it critically for important intellectual content, Final approval of the version to be published Jay A Yelon – Analysis and interpretation of data, Revising it critically for important intellectual content, Final approval of the version to be published Valerie Katz – Analysis and interpretation of data, Revising it critically for important intellectual content, Final approval of the version to be published Robert V Madlinger – Analysis and interpretation of data, Revising it critically for important intellectual content, Final approval of the version to be published |
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Guarantor of submission
The corresponding author is the guarantor of submission. |
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Source of support
None |
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Conflict of interest
Authors declare no conflict of interest. |
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Copyright
© Basem Marcos et al. 2013; This article is distributed the terms of Creative Commons Attribution License which permits unrestricted use, distribution and reproduction in any means provided the original authors and original publisher are properly credited. (Please see Copyright Policy for more information.) |
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