Citation Information :
Mansilla S, Pouy A, Brito N, Zubiaurre V, Cubas S, Muniz N, Machado F. Nonoperative Management of Retrohepatic Vena Cava Penetrating Trauma. Panam J Trauma Crit Care Emerg Surg 2023; 12 (1):25-29.
Background: Despite advances in trauma care, injuries to the inferior vena cava (IVC) continue to have a high mortality rate, up to 75%. An exceptional proportion of patients can be considered for nonoperative management (NOM). They require specific therapeutic management and represent a challenge for the surgical team.
Objective: A case report of a 33-year-old patient with penetrating retrohepatic vena cava trauma with successful NOM and literature review is presented.
Design and methodology: Bibliographic review was carried out in the PubMed, Cochrane library, Scielo, and Latin American and Caribbean Health Sciences Literature (LILACS) databases.
Results: The absolute conditions for NOM of penetrating retrohepatic vena cava trauma are: hemodynamic stability, absence of peritoneal irritation and admission to an intensive care unit with computed tomography (CT) and surgical block available 24 hours. Main questions arise regarding the opportunity for imaging control, absolute rest indication, and thromboprophylaxis.
Conclusion: Retrohepatic vena cava injury is associated with fatal outcomes. In a selected group of patients, NOM is a valid therapeutic option. Close monitoring and follow-ups are necessary.
Trauma AA of S of The American Association for the Surgery of Trauma. Injury Scoring Scale. 2018.
Khan IR, Khan FM, Youssef AM, et al. Nonoperative management of contained retrohepatic caval injury. Ann Vasc Surg 2012;26(3):420.e9–420.e12. DOI: 10.1016/j.avsg.2011.05.042
Tarchouli M, Elabsi M, Njoumi N, et al. Hepatobiliary & pancreatic diseases international liver trauma: what current management? Hepatobiliary Pancreat Dis Int 2018;17(1):39–44. DOI: 10.1016/j.hbpd.2018.01.013
Goin G, Massalou D, Bege T, et al. Feasibility of selective non-operative management for penetrating abdominal trauma in France. J Visc Surg 2017;167–174. DOI: 10.1016/j.jviscsurg.2016.08.006
Jansen JO, Inaba K, Rizoli SB, et al. Selective non-operative management of penetrating abdominal injury in Great Britain and Ireland: survey of practice. Injury 2012;43(11):1799–1804. DOI: 10.1016/j.injury.2011.03.062
MacGoey P, Navarro A, Beckingham IJ, et al. Selective non-operative management of penetrating liver injuries at a UK tertiary referral centre. Ann R Coll Surg Engl 2014;96(6):423–426. DOI: 10.1308/003588414X13946184901524
Swift C, Garner JP. Non-operative management of liver trauma. J R Army Med Corps 2012;158(2):85–96. DOI: 10.1136/jramc-158-02-04
McGreevy CM, Anjaria DJ, Kunac A. Nonoperative management of a penetrating injury to the retrohepatic inferior vena cava. Am Surg 2016;82(8):212–213. DOI: 10.1177/000313481608200815
Alzamel HA, Cohn SM. When is it safe to discharge asymptomatic patients with abdominal stab wounds? J Trauma 2005;58(3):523–525. DOI: 10.1097/01.ta.0000152987.21630.39
Bala M, Gazalla SA, Faroja M, et al. Complications of high grade liver injuries: management and outcome with focus on bile leaks. Scand J Trauma Resusc Emerg Med 2012;20:20. DOI: 10.1186/1757-7241-20-20
Teichman A, Scantling D, McCracken B, et al. Early mobilization of patients with non-operative liver and spleen injuries is safe and cost effective. Eur J Trauma Emerg Surg 2018;44(6):883–887. DOI: 10.1007/s00068-017-0864-9
Paffrath T, Wafaisade A, Lefering R, et al. Venous thromboembolism after severe trauma: Incidence, risk factors and outcome. Injury 2010;41(1):97–101. DOI: 10.1016/j.injury.2009.06.010
Rogers F, Cipolle M, Velmahos G, et al. Practice management guidelines for the prevention of venous thromboembolism in trauma patients: the EAST practice management guidelines work group. J Trauma 2002;53(1):142–164. DOI: 10.1097/00005373-200207000-00032
Guyatt GH, Akl EA, Crowther M, et al. American College of Chest Physicians Antithrombotic Therapy and Prevention of Thrombosis Panel Executive summary. Antithrombotic therapy and prevention of thrombosis, 9th ed: American College of Chest Physicians evidence-based clinical practice guidelines. Chest. 2012;141:7S–42S.
Skarupa D, Hanna K, Zeeshan M, et al. Is early chemical thromboprophylaxis in patients with solid organ injury a solid decision? J Trauma Acute Care Surg 2019;87(5):1104–1112. DOI: 10.1097/TA.0000000000002438
Ferguson C, Lewin J. BET 2: is early chemical thromboprophylaxis safe in patients with blunt trauma solid organ injury (SOI) undergoing non-operative management (NOM)? Emerg Med J 2018;35(2):127–129. DOI: 10.1136/emermed-2017-207424.3
Markert DJ, Shanmuganathan K, Mirvis SE, et al. Budd-Chiari syndrome resulting from intrahepatic ivc compression secondary to blunt hepatic trauma. Clin Radiol 1997;52(5):384–387. DOI: 10.1016/s0009-9260(97)80135-3