title: [Successful treatment of retrohepatic inferior vena cava injury: report of two cases].
abstract: Authors present two cases of successfully operated patients with retrohepatic inferior vena cava (IVC) injury. In the first case a 79 year old female patient suffered from multiple stab wounds in the area of the 4th segment of the right lung as well as in the retrohepatic region in close proximity to the IVC. At the time of the first surgery the IVC injury was not identified. During a second operation, however, the IVC was isolated from the liver using an anterior dissection of the parenchyma with finger-fracture technique and the injury was oversawn finally. Successful haemostasis of the liver was achieved by packing of the perihepatic space, which was removed three days later. In the second case a 25 year-old male patient had suffered blunt abdominal trauma. He underwent laparotomy and packing on the site of the hepatic injury, which had to be repeated seven more times. Later on, another urgent laparotomy was carried out for recurring intraabdominal bleeding and bile leakage, and cholecystectomy was performed due to gallbladder perforation. Another two days later a further emergency laparotomy was indicated for ongoing intraabdominal bleeding, when the bleeding source - an injury (3 mm in diameter) of the retrohepatic IVC - was oversawn. After relatively long postoperative stay both patients were fully recovered and discharged from hospital.
  
  
  CONCLUSIONS
  penetrating injuries of the IVC are associated with high mortality rate of approximately 78%. Proper management of these injuries requires experience in both vascular and liver surgery. Retrohepatic IVC injury needs to be considered in the differential diagnosis of ongoing bleeding in penetrating or blunt liver trauma. Packing of the liver is a reliable haemostatic method if bleeding persists due to division of the liver parenchyma.
authors: Debreceni Egyetem Orvos- és Egészségtudományi Centrum Sebészeti Intézet 4032 Debrecen Móricz Zs. krt. 22. szakaga@yahoo.com
authors: Károly Gábor
authors: KG
authors: Szabó
authors: Adrienn
authors: A
authors: Csiszkó
authors: László
authors: L
authors: Sasi-Szabó
authors: Sándor
authors: S
authors: Bányai
authors: Zoltán
authors: Z
authors: Szentkereszty
authors: Zsigmond
authors: Z
authors: Varga
authors: Károly
authors: K
authors: Fekete
authors: Péter
authors: P
authors: Sápy
authors: László
authors: L
authors: Damjanovich
authors: Zsolt
authors: Z
authors: Szentkereszty
mesh_terms: D000007:Abdominal Injuries / Q000601:surgery*; D000328:Adult; D000368:Aged; D004638:Emergency Treatment; D005260:Female; D006470:Hemorrhage / Q000209:etiology / Q000601:surgery*; D006801:Humans; D007813:Laparotomy; D008099:Liver / Q000293:injuries* / Q000601:surgery*; D008297:Male; D012086:Reoperation; D014656:Vascular Surgical Procedures; D014682:Vena Cava, Inferior / Q000293:injuries* / Q000601:surgery*; D014949:Wounds, Nonpenetrating / Q000601:surgery*; D014950:Wounds, Penetrating / Q000601:surgery*