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Abstract
During the last 5 years, 10 gunshot and 2 stab wounds of the inferior vena cava have
been treated, with 11 survivals and 1 death. The lacerations were above the renal
veins in 4 cases and below in the others. All patients had other serious visceral
injuries. Treatment consisted of suture repair in 11 cases and ligation in the twelfth.
Upon exploration, free intraperitoneal bleeding from the caval wound had ceased in
every case. The signal finding was a retroperitoneal hematoma which was often deceptively
small. Commonly, the surgeon explored the retroperitoneal space in order to treat
other visceral injuries, only to be confronted with unexpected massive hemorrhage
when the hematoma was entered. Difficulties in controlling the bleeding are often
related to the well-developed collateral system by which different segments of the
inferior vena cava are freely connected.
When a hematoma is found in the vicinity of the great vessels and the retroperitoneal
space is to be explored, certain precautions should be observed. These include provision
for adequate exposure, procurement of blood, and adjustment of lighting. Additional
help can be summoned and vascular instruments should be brought to the operating table.
A large-bore needle or cut-down should be placed in an arm vein. The posterior peritoneal
incision should be planned for maximum and rapid exposure, so that hemorrhage can
be quickly controlled when the plane of the hematoma is entered.
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Article info
Publication history
Received:
February 24,
1961
Footnotes
☆Supported by grants from the Chicago and the American Heart Association.
Identification
Copyright
© 1962 Published by Elsevier Inc.
