Treatment of Retrohepatic Caval Injury using Total Hepatic Vascular Isolation and Venovenous Bypass.
- Author:
Kyu Eun LEE
1
;
Hyuk Joon LEE
;
Sang Beom KIM
;
Seong Hoon KIM
;
Kwang Sik KIM
;
Kyu Hee HER
;
Kyung Suk SUH
;
Kuhn Uk LEE
Author Information
1. Department of Surgery, Seoul National University College of Medicine, Seoul, Korea. kulee@plaza.snu.ac.kr
- Publication Type:Case Report
- Keywords:
Liver trauma;
Total hepatic vascular isolation;
Venovenous bypass;
Interhospital transfer
- MeSH:
Accidents, Traffic;
Adult;
Axillary Vein;
Constriction;
Female;
Femoral Vein;
Hemorrhage;
Hemostasis;
Heparin;
Hepatectomy;
Hepatic Veins;
Humans;
Jeju-do;
Mortality;
Prognosis;
Seoul;
Vital Signs
- From:Korean Journal of Hepato-Biliary-Pancreatic Surgery
2002;6(1):107-110
- CountryRepublic of Korea
- Language:Korean
-
Abstract:
Retrohepatic caval injuries are a difficult problem to surgeons as its mortality approaching 50~80%. Several bypass techniques was advocated to reduce operative bleeding and to improve the prognosis of the traumatized patients. We successfully managed a case of retro hepatic caval injury using venovenous bypass and total hepatic vascular isolation. A 28 year old female patients was admitted to Cheju Medical Center injured in a traffic accident. At exploration, a retrohepatic caval injury was suspected. So patient was emergently transferred to Seoul National University Hospital, after gauze packing. On arrival, vital signs were stable. Reexploration was undertaken. There was gush out of blood from retrohepatic space. After clamping suprahepatic and infrahepatic vena cava, venovenous bypass was introduced to left axillary vein and left femoral vein using Biomedicus pump. Systemic heparinization was not used. Avulsion between vena cava and common trunk of left and middle hepatic veins was repaired and left hepatectomy was done. Gauze packing was done due to ongoing oozing by coagulopathy from massive transfusion. Total venovenous bypass time was 30 min. On 10th operative day, reexploration was undertaken to assure hemostasis and to remove packed gauze. On 54th postoperative day patient discharged without any morbidity.
