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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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Received: February 24, 1961
☆Supported by grants from the Chicago and the American Heart Association.
© 1962 Published by Elsevier Inc.